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• http://doi.org/10.1186/s12884-020-03199-x
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• {"id"=>"524635862521217024", "text"=>"Our study #PLOSMedicine: Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery http://t.co/yGxkoUTnKN", "created_at"=>"2014-10-21T18:58:31Z", "user"=>"katybkoz", "user_name"=>"Katy B. Kozhimannil", "user_profile_image"=>"http://pbs.twimg.com/profile_images/427509223191105537/1KqjzkVV_normal.jpeg"}
• {"id"=>"524660325639933952", "text"=>"'Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery' from @katybkoz and colleagues http://t.co/eCsKSu38Y7", "created_at"=>"2014-10-21T20:35:44Z", "user"=>"PLOSMedicine", "user_name"=>"PLOS Medicine", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2436335697/k93oob5au2gllc775hk5_normal.jpeg"}
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• {"id"=>"524661506282360833", "text"=>"RT @PLOSMedicine: 'Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery' from @katybkoz and colleagues http:…", "created_at"=>"2014-10-21T20:40:25Z", "user"=>"ziadkhatib", "user_name"=>"Ziad El-Khatib", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1792871071/ZiadElKhatib_normal.JPG"}
• {"id"=>"524665957852393472", "text"=>"#plos Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery: Analyses of a Natio.. http://t.co/Jd2NNhEesD", "created_at"=>"2014-10-21T20:58:06Z", "user"=>"bookapharmacist", "user_name"=>"Kazeem Olalekan", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1859820850/3a_normal.png"}
• {"id"=>"524724307201511424", "text"=>"#PLOSMedicine: Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery http://t.co/SyUkEFAMK3 @lievarojas", "created_at"=>"2014-10-22T00:49:58Z", "user"=>"ElardKoch", "user_name"=>"Elard Koch", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1652904874/koch2_normal.JPG"}
• {"id"=>"524727652289368064", "text"=>"RT @ElardKoch: #PLOSMedicine: Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery http://t.co/SyUkEFAMK3 @l…", "created_at"=>"2014-10-22T01:03:15Z", "user"=>"daneliacardona", "user_name"=>"danelia cardona", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000829889764/86bdf3847d859b247133380a7e318927_normal.jpeg"}
• {"id"=>"524732411553538048", "text"=>"C-section rate not based on mother's medical needs - Unwarranted practice variations - http://t.co/pQT9zXYdK4", "created_at"=>"2014-10-22T01:22:10Z", "user"=>"EIPConsult", "user_name"=>"JW Matheson", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2436371363/bp21c0wygu6krf1nd7w0_normal.jpeg"}
• {"id"=>"524733673435066370", "text"=>"RT @ElardKoch: #PLOSMedicine: Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery http://t.co/SyUkEFAMK3 @l…", "created_at"=>"2014-10-22T01:27:11Z", "user"=>"HelenaOssa", "user_name"=>"DOÑA. ", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3688856624/fd0f281172036e21302972ee63d57a35_normal.jpeg"}
• {"id"=>"524916559597170691", "text"=>"Maternal Clinical Diagnoses & Hospital Variation in the Risk of Cesarean Delivery... http://t.co/FAQ0WemN0K #pub6806 #admindata", "created_at"=>"2014-10-22T13:33:54Z", "user"=>"RbcSchlz", "user_name"=>"Rebecca", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000774681417/5d0f5e8f15e7c87c4e3999f578747f57_normal.jpeg"}
• {"id"=>"525261972804497408", "text"=>"PLOS Med: Mat. Clin. Diagnoses and Hosp Variation in Risk of Cesarean Delivery: Analyses of a Natl US Hospital Dbase http://t.co/InFlnNAayc", "created_at"=>"2014-10-23T12:26:27Z", "user"=>"MET_LSHTM", "user_name"=>"MET - LSHTM", "user_profile_image"=>"http://pbs.twimg.com/profile_images/524565110077935617/_VMEPxBu_normal.jpeg"}
• {"id"=>"525262375835144193", "text"=>"RT @MET_LSHTM: PLOS Med: Mat. Clin. Diagnoses and Hosp Variation in Risk of Cesarean Delivery: Analyses of a Natl US Hospital Dbase http://…", "created_at"=>"2014-10-23T12:28:03Z", "user"=>"calynch5", "user_name"=>"ca_lynch", "user_profile_image"=>"http://pbs.twimg.com/profile_images/524115264288604160/iTH40Kjj_normal.jpeg"}
• {"id"=>"525930121081790466", "text"=>"US. Variation in cesarean section across hospitals, not explained by differences in maternal clinical diagnoses. \nhttp://t.co/jMy3xOc0Ku", "created_at"=>"2014-10-25T08:41:26Z", "user"=>"JuanGrvas", "user_name"=>"Juan Gérvas", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2627753335/IMGP1408_normal.JPG"}
• {"id"=>"525930344583688192", "text"=>"Estados Unidos. Cesáreas. Variabilidad interhospitalaria no explicada por diferencias en diagnósticos clínicos. \nhttp://t.co/jMy3xOc0Ku", "created_at"=>"2014-10-25T08:42:20Z", "user"=>"JuanGrvas", "user_name"=>"Juan Gérvas", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2627753335/IMGP1408_normal.JPG"}
• {"id"=>"525939289322823680", "text"=>"RT @JuanGrvas: Estados Unidos. Cesáreas. Variabilidad interhospitalaria no explicada por diferencias en diagnósticos clínicos. \nhttp://t.co…", "created_at"=>"2014-10-25T09:17:52Z", "user"=>"mafgaleano", "user_name"=>"M. Fernandez Galeano", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3307270471/207a67776e4e21fe9c8e5c093807ad5d_normal.jpeg"}
• {"id"=>"525940388456960001", "text"=>"Maternal Clinic Diagn&Hospital Variation in the Risk of Cesarean Delivery http://t.co/2bKi1DMkPm love they include Why Was This Study Done?", "created_at"=>"2014-10-25T09:22:14Z", "user"=>"arias_america", "user_name"=>"America Arias", "user_profile_image"=>"http://pbs.twimg.com/profile_images/524493636/AMERICA7_normal.jpg"}
• {"id"=>"525944897644544000", "text"=>"RT @JuanGrvas: Estados Unidos. Cesáreas. Variabilidad interhospitalaria no explicada por diferencias en diagnósticos clínicos. \nhttp://t.co…", "created_at"=>"2014-10-25T09:40:09Z", "user"=>"CarlosGeversDC", "user_name"=>"Carlos Gevers", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2619264062/iwm59i6inp48vqw51ggo_normal.jpeg"}
• {"id"=>"525958800168460288", "text"=>"RT @JuanGrvas: Estados Unidos. Cesáreas. Variabilidad interhospitalaria no explicada por diferencias en diagnósticos clínicos. \nhttp://t.co…", "created_at"=>"2014-10-25T10:35:24Z", "user"=>"Meryonetwothree", "user_name"=>"Matrona Taurt", "user_profile_image"=>"http://pbs.twimg.com/profile_images/419837024804147200/xdf4P9qc_normal.jpeg"}
• {"id"=>"525987620409843712", "text"=>"RT @JuanGrvas: US. Variation in cesarean section across hospitals, not explained by differences in maternal clinical diagnoses. \nhttp://t.c…", "created_at"=>"2014-10-25T12:29:55Z", "user"=>"ConsultaFamili", "user_name"=>"Consulta Familiar ", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3736990536/db5ecc1072dfbbd8380ac5bfacc87c7f_normal.jpeg"}
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• {"id"=>"525995583795126272", "text"=>"RT @JuanGrvas: Estados Unidos. Cesáreas. Variabilidad interhospitalaria no explicada por diferencias en diagnósticos clínicos. \nhttp://t.co…", "created_at"=>"2014-10-25T13:01:34Z", "user"=>"majolinaprimera", "user_name"=>"maria josé", "user_profile_image"=>"http://pbs.twimg.com/profile_images/430810962460155904/cV6Vi2jv_normal.jpeg"}
• {"id"=>"525999875117555712", "text"=>"RT @JuanGrvas: Estados Unidos. Cesáreas. Variabilidad interhospitalaria no explicada por diferencias en diagnósticos clínicos. \nhttp://t.co…", "created_at"=>"2014-10-25T13:18:37Z", "user"=>"parreshia", "user_name"=>"Marcelo Avellanal L", "user_profile_image"=>"http://pbs.twimg.com/profile_images/422299459469324289/kjHQnE-y_normal.jpeg"}
• {"id"=>"526505861485981696", "text"=>"CS Risk variability http://t.co/1PdOpWvqwv via @PLOSMedicine .@WeMidwives @world_midwives @SagefemmeSB @UCCMidwifery #Globalvillagemidwives", "created_at"=>"2014-10-26T22:49:14Z", "user"=>"DeirdreMunro", "user_name"=>"Deirdre Munro", "user_profile_image"=>"http://pbs.twimg.com/profile_images/487365941312102400/9zLNeXY-_normal.jpeg"}
• {"id"=>"526515648705597440", "text"=>"RT @DeirdreMunro: CS Risk variability http://t.co/1PdOpWvqwv via @PLOSMedicine .@WeMidwives @world_midwives @SagefemmeSB @UCCMidwifery #Glo…", "created_at"=>"2014-10-26T23:28:07Z", "user"=>"gemd1981", "user_name"=>"gemma sykes", "user_profile_image"=>"http://pbs.twimg.com/profile_images/442601586301632512/qG3zymiQ_normal.jpeg"}
• {"id"=>"526633553086664704", "text"=>"RT @DeirdreMunro: CS Risk variability http://t.co/1PdOpWvqwv via @PLOSMedicine .@WeMidwives @world_midwives @SagefemmeSB @UCCMidwifery #Glo…", "created_at"=>"2014-10-27T07:16:38Z", "user"=>"luybenans", "user_name"=>"Ans Luyben", "user_profile_image"=>"http://pbs.twimg.com/profile_images/500743143797829632/Tkix6nKd_normal.jpeg"}
• {"id"=>"526635052432883712", "text"=>"RT @DeirdreMunro: CS Risk variability http://t.co/1PdOpWvqwv via @PLOSMedicine .@WeMidwives @world_midwives @SagefemmeSB @UCCMidwifery #Glo…", "created_at"=>"2014-10-27T07:22:35Z", "user"=>"SagefemmeSB", "user_name"=>"Sheena Byrom", "user_profile_image"=>"http://pbs.twimg.com/profile_images/522599334681255937/UKWmEdBR_normal.jpeg"}
• {"id"=>"526695564323192832", "text"=>"RT @DeirdreMunro: CS Risk variability http://t.co/1PdOpWvqwv via @PLOSMedicine .@WeMidwives @world_midwives @SagefemmeSB @UCCMidwifery #Glo…", "created_at"=>"2014-10-27T11:23:02Z", "user"=>"UCCMidwifery", "user_name"=>"Rhona O'Connell", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2363464959/vp8l3umj9xq4gb9xr704_normal.jpeg"}
• {"id"=>"527018128350273537", "text"=>"Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery: Analyses of a National U... http://t.co/kiNTbqHXHU", "created_at"=>"2014-10-28T08:44:47Z", "user"=>"gregoireficheur", "user_name"=>"Grégoire Ficheur", "user_profile_image"=>"http://pbs.twimg.com/profile_images/489423359415812097/Au81OaQD_normal.jpeg"}
• {"id"=>"527530541218668544", "text"=>"new study shows that c-section rates have more to do with hospital culture than maternal risk: http://t.co/XnX0Dz9QZ8", "created_at"=>"2014-10-29T18:40:56Z", "user"=>"sdgottlieb", "user_name"=>"S.D. Gottlieb", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1553018713/image_normal.jpg"}
• {"id"=>"527985858725822465", "text"=>"We're reading: #PLOSMedicine: Maternal Clinical Diagnoses & Hospital Variation in the Risk of #Cesarean http://t.co/G3m1SoA1L7", "created_at"=>"2014-10-31T00:50:12Z", "user"=>"cmqcc", "user_name"=>"CMQCC", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2188235656/CMQCC_square_normal.jpg"}
• {"id"=>"528490062816624641", "text"=>"#PLOSMedicine: Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery:http://t.co/hpEO9AS8lf", "created_at"=>"2014-11-01T10:13:44Z", "user"=>"rescuriet", "user_name"=>"Ramón Escuriet", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000836949775/357d9856eec078bf3571efe23ee1f63a_normal.jpeg"}
• {"id"=>"528506187650969601", "text"=>"RT @rescuriet: #PLOSMedicine: Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery:http://t.co/hpEO9AS8lf", "created_at"=>"2014-11-01T11:17:49Z", "user"=>"luybenans", "user_name"=>"Ans Luyben", "user_profile_image"=>"http://pbs.twimg.com/profile_images/500743143797829632/Tkix6nKd_normal.jpeg"}
• {"id"=>"528511256802906112", "text"=>"“@rescuriet: #PLOSMedicine: Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery:http://t.co/lcM6AsxYlH”👏📑👍", "created_at"=>"2014-11-01T11:37:57Z", "user"=>"DeirdreMunro", "user_name"=>"Deirdre Munro", "user_profile_image"=>"http://pbs.twimg.com/profile_images/487365941312102400/9zLNeXY-_normal.jpeg"}
• {"id"=>"530495327325798400", "text"=>"Regardless of risk factors, chances of having a first cesarean vary between 11% & 36% across hospitals reviewed http://t.co/Urc06E0Vlt #Why?", "created_at"=>"2014-11-06T23:01:56Z", "user"=>"CarolynHastie", "user_name"=>"Carolyn Hastie", "user_profile_image"=>"http://pbs.twimg.com/profile_images/422625520358916096/ln8ZKtuG_normal.jpeg"}
• {"id"=>"530501939889700866", "text"=>"RT @CarolynHastie: Regardless of risk factors, chances of having a first cesarean vary between 11% & 36% across hospitals reviewed http://t…", "created_at"=>"2014-11-06T23:28:13Z", "user"=>"SarahDavies56", "user_name"=>"Sarah Davies", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000381431576/5ed2614f21f4ec796834f39d0d0cc3e2_normal.jpeg"}
• {"id"=>"530579007822385152", "text"=>"帝王切開するかどうかは患者の診断や社会人口学的要因、病院の特徴を統制しても、病院ごとに違う。Maternal Clinical Diagnoses and Hospital Variation in the Risk of … http://t.co/uYHQ7dMEDq", "created_at"=>"2014-11-07T04:34:27Z", "user"=>"uranus_2", "user_name"=>"マーキュリー２世", "user_profile_image"=>"http://pbs.twimg.com/profile_images/520761051646676992/x2e9wBQE_normal.png"}
• {"id"=>"530669377394597888", "text"=>"RT @CarolynHastie: Regardless of risk factors, chances of having a first cesarean vary between 11% & 36% across hospitals reviewed http://t…", "created_at"=>"2014-11-07T10:33:33Z", "user"=>"MvmntRvltn", "user_name"=>"Petra Fisher", "user_profile_image"=>"http://pbs.twimg.com/profile_images/502409729935564801/InSaEe7O_normal.jpeg"}
• {"id"=>"734853947974782976", "text"=>"@robyncnm @childbirth This is such an important question. We are looking for answers. It's not just case mix. https://t.co/eP4EuamAw6", "created_at"=>"2016-05-23T21:10:08Z", "user"=>"katybkoz", "user_name"=>"Katy B. Kozhimannil", "user_profile_image"=>"http://pbs.twimg.com/profile_images/622156442020130816/edGEiG62_normal.jpg"}
• {"id"=>"734854408056360964", "text"=>"RT @katybkoz: @robyncnm @childbirth This is such an important question. We are looking for answers. It's not just case mix. https://t.co/eP…", "created_at"=>"2016-05-23T21:11:58Z", "user"=>"robyncnm", "user_name"=>"Robyn Churchill, CNM", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000506759140/f0f7c3d4dfd710de8df48f54c297554c_normal.jpeg"}

Wikipedia

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Figshare

• {"files"=>["https://ndownloader.figshare.com/files/1726494"], "description"=>"<p>Models also control for state fixed effects. Bayesian one-tailed <i>p</i>-values based on posterior distributions.</p><p>*<i>p</i><0.05,</p><p>**<i>p</i><0.01,</p><p>***<i>p</i><0.001.</p><p>OR, odds ratio.</p><p>Parameter estimates from multilevel models of the association between patient and hospital covariates with odds of cesarean delivery, overall and among women with no prior cesareans.</p>", "links"=>[], "tags"=>["Hospital Discharge Database BackgroundCesarean delivery", "cesarean section", "2010 Nationwide Inpatient Sample", "cesarean section use.Please", "hospital discharge records", "25 percentage points", "Maternal Clinical Diagnoses"], "article_id"=>1211661, "categories"=>["Biological Sciences"], "users"=>["Katy B. Kozhimannil", "Mariana C. Arcaya", "S. V. Subramanian"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001745.t004", "stats"=>{"downloads"=>1, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Parameter_estimates_from_multilevel_models_of_the_association_between_patient_and_hospital_covariates_with_odds_of_cesarean_delivery_overall_and_among_women_with_no_prior_cesareans_/1211661", "title"=>"Parameter estimates from multilevel models of the association between patient and hospital covariates with odds of cesarean delivery, overall and among women with no prior cesareans.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-10-21 04:06:08"}
• {"files"=>["https://ndownloader.figshare.com/files/1726493"], "description"=>"<p>Hospital variance and 95% credible interval for null analyses and analyses fully adjusted for covariates listed in <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001745#pmed-1001745-t002\" target=\"_blank\">Table 2</a>, from a multilevel model of births nested in hospitals.</p>", "links"=>[], "tags"=>["Hospital Discharge Database BackgroundCesarean delivery", "cesarean section", "2010 Nationwide Inpatient Sample", "cesarean section use.Please", "hospital discharge records", "25 percentage points", "Maternal Clinical Diagnoses"], "article_id"=>1211660, "categories"=>["Biological Sciences"], "users"=>["Katy B. Kozhimannil", "Mariana C. Arcaya", "S. V. Subramanian"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001745.t003", "stats"=>{"downloads"=>5, "page_views"=>14, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Hospital_variance_and_95_credible_interval_for_null_analyses_and_analyses_fully_adjusted_for_covariates_listed_in_Table_2_from_a_multilevel_model_of_births_nested_in_hospitals_/1211660", "title"=>"Hospital variance and 95% credible interval for null analyses and analyses fully adjusted for covariates listed in Table 2, from a multilevel model of births nested in hospitals.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-10-21 04:06:08"}
• {"files"=>["https://ndownloader.figshare.com/files/1726490"], "description"=>"<p>Populations include all births, all births to women with no prior cesarean delivery, all births to lower risk women (those with term, singleton, vertex pregnancies and no prior cesarean delivery), and all births to higher risk women (those with a preterm, multiple gestation, or nonvertex pregnancy or prior cesarean delivery). Factors included in adjusted models are diagnosis of maternal hypertension, diabetes, hemorrhage or placental complications, fetal distress, and fetal disproportion or obstructed labor; maternal age, race/ethnicity, and insurance status; hospital bed size and location/teaching status; and state-level fixed effects.</p>", "links"=>[], "tags"=>["Hospital Discharge Database BackgroundCesarean delivery", "cesarean section", "2010 Nationwide Inpatient Sample", "cesarean section use.Please", "hospital discharge records", "25 percentage points", "Maternal Clinical Diagnoses"], "article_id"=>1211657, "categories"=>["Biological Sciences"], "users"=>["Katy B. Kozhimannil", "Mariana C. Arcaya", "S. V. Subramanian"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001745.g002", "stats"=>{"downloads"=>3, "page_views"=>19, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Between_hospital_variation_in_cesarean_deliveries_overall_and_for_subgroups_of_women_null_and_fully_adjusted_models_/1211657", "title"=>"Between-hospital variation in cesarean deliveries overall and for subgroups of women, null and fully adjusted models.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-10-21 04:06:08"}
• {"files"=>["https://ndownloader.figshare.com/files/1726488"], "description"=>"<p>Funnel plots show how each individual institution (blue dot) performs compared to the mean (red) and control limits (the 99% prediction interval around the calculated mean). The upper control limit is shown as purple and the lower control limit is shown as green. Cesarean rates for (A) all women, (B) women with no prior cesarean, (C) lower risk women, and (D) higher risk women.</p>", "links"=>[], "tags"=>["Hospital Discharge Database BackgroundCesarean delivery", "cesarean section", "2010 Nationwide Inpatient Sample", "cesarean section use.Please", "hospital discharge records", "25 percentage points", "Maternal Clinical Diagnoses"], "article_id"=>1211655, "categories"=>["Biological Sciences"], "users"=>["Katy B. Kozhimannil", "Mariana C. Arcaya", "S. V. Subramanian"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001745.g001", "stats"=>{"downloads"=>0, "page_views"=>17, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Funnel_plots_of_hospital_cesarean_rates_overall_and_for_subgroups_of_women_/1211655", "title"=>"Funnel plots of hospital cesarean rates, overall and for subgroups of women.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-10-21 04:06:08"}
• {"files"=>["https://ndownloader.figshare.com/files/1726498", "https://ndownloader.figshare.com/files/1726499"], "description"=>"<div><p>Background</p><p>Cesarean delivery is the most common inpatient surgery in the United States, where 1.3 million cesarean sections occur annually, and rates vary widely by hospital. Identifying sources of variation in cesarean use is crucial to improving the consistency and quality of obstetric care. We used hospital discharge records to examine the extent to which variability in the likelihood of cesarean section across US hospitals was attributable to individual women's clinical diagnoses.</p><p>Methods and Findings</p><p>Using data from the 2009 and 2010 Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project—a 20% sample of US hospitals—we analyzed data for 1,475,457 births in 1,373 hospitals. We fitted multilevel logistic regression models (patients nested in hospitals). The outcome was cesarean (versus vaginal) delivery. Covariates included diagnosis of diabetes in pregnancy, hypertension in pregnancy, hemorrhage during pregnancy or placental complications, fetal distress, and fetal disproportion or obstructed labor; maternal age, race/ethnicity, and insurance status; and hospital size and location/teaching status.</p><p>The cesarean section prevalence was 22.0% (95% confidence interval 22.0% to 22.1%) among women with no prior cesareans. In unadjusted models, the between-hospital variation in the individual risk of primary cesarean section was 0.14 (95% credible interval 0.12 to 0.15). The difference in the probability of having a cesarean delivery between hospitals was 25 percentage points. Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics (0.16 [95% credible interval 0.14 to 0.18]). A limitation is that these data, while nationally representative, did not contain information on parity or gestational age.</p><p>Conclusions</p><p>Variability across hospitals in the individual risk of cesarean section is not decreased by accounting for differences in maternal diagnoses. These findings highlight the need for more comprehensive or linked data including parity and gestational age as well as examination of other factors—such as hospital policies, practices, and culture—in determining cesarean section use.</p><p><i>Please see later in the article for the Editors' Summary</i></p></div>", "links"=>[], "tags"=>["Hospital Discharge Database BackgroundCesarean delivery", "cesarean section", "2010 Nationwide Inpatient Sample", "cesarean section use.Please", "hospital discharge records", "25 percentage points", "Maternal Clinical Diagnoses"], "article_id"=>1211665, "categories"=>["Biological Sciences"], "users"=>["Katy B. Kozhimannil", "Mariana C. Arcaya", "S. V. Subramanian"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001745.s001", "https://dx.doi.org/10.1371/journal.pmed.1001745.s002"], "stats"=>{"downloads"=>4, "page_views"=>16, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Maternal_Clinical_Diagnoses_and_Hospital_Variation_in_the_Risk_of_Cesarean_Delivery_Analyses_of_a_National_US_Hospital_Discharge_Database_/1211665", "title"=>"Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery: Analyses of a National US Hospital Discharge Database", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2014-10-21 04:06:08"}
• {"files"=>["https://ndownloader.figshare.com/files/1726496"], "description"=>"<p>Models also control for state fixed effects. Bayesian one-tailed <i>p</i>-values based on posterior distributions.</p><p>*<i>p</i><0.05,</p><p>**<i>p</i><0.01,</p><p>***<i>p</i><0.001.</p><p>OR, odds ratio.</p><p>Parameter estimates from multilevel models of the association between patient and hospital covariates with odds of cesarean delivery for risk-based subgroups of women.</p>", "links"=>[], "tags"=>["Hospital Discharge Database BackgroundCesarean delivery", "cesarean section", "2010 Nationwide Inpatient Sample", "cesarean section use.Please", "hospital discharge records", "25 percentage points", "Maternal Clinical Diagnoses"], "article_id"=>1211663, "categories"=>["Biological Sciences"], "users"=>["Katy B. Kozhimannil", "Mariana C. Arcaya", "S. V. Subramanian"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001745.t005", "stats"=>{"downloads"=>0, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Parameter_estimates_from_multilevel_models_of_the_association_between_patient_and_hospital_covariates_with_odds_of_cesarean_delivery_for_risk_based_subgroups_of_women_/1211663", "title"=>"Parameter estimates from multilevel models of the association between patient and hospital covariates with odds of cesarean delivery for risk-based subgroups of women.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-10-21 04:06:08"}
• {"files"=>["https://ndownloader.figshare.com/files/1726492"], "description"=>"<p>US 2009–2010 births to all women and women with no prior cesarean: sample size, percentage frequency distribution, and percentage of women with cesarean deliveries and 95% confidence intervals by covariate.</p>", "links"=>[], "tags"=>["Hospital Discharge Database BackgroundCesarean delivery", "cesarean section", "2010 Nationwide Inpatient Sample", "cesarean section use.Please", "hospital discharge records", "25 percentage points", "Maternal Clinical Diagnoses"], "article_id"=>1211659, "categories"=>["Biological Sciences"], "users"=>["Katy B. Kozhimannil", "Mariana C. Arcaya", "S. V. Subramanian"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001745.t002", "stats"=>{"downloads"=>1, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_US_2009_8211_2010_births_to_all_women_and_women_with_no_prior_cesarean_sample_size_percentage_frequency_distribution_and_percentage_of_women_with_cesarean_deliveries_and_95_confidence_intervals_by_covariate_/1211659", "title"=>"US 2009–2010 births to all women and women with no prior cesarean: sample size, percentage frequency distribution, and percentage of women with cesarean deliveries and 95% confidence intervals by covariate.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-10-21 04:06:08"}
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PMC Usage Stats | Further Information

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Relative Metric

{"start_date"=>"2014-01-01T00:00:00Z", "end_date"=>"2014-12-31T00:00:00Z", "subject_areas"=>[{"subject_area"=>"/Engineering and technology", "average_usage"=>[282]}, {"subject_area"=>"/Medicine and health sciences", "average_usage"=>[285]}, {"subject_area"=>"/Medicine and health sciences/Health care", "average_usage"=>[283, 456]}]}

F1000Prime