AI Article Synopsis
- Cesarean delivery rates differ significantly across U.S. hospitals, and while patient and hospital factors are known contributors, cultural influences are suspected but not well measured.
- Researchers developed and tested a Labor Culture Survey (LCS) involving 1718 healthcare providers from 70 hospitals, leading to a final survey with 29 items across six subscales related to cesarean overuse.
- The study confirms that the LCS is a valid tool for assessing factors associated with cesarean rates, highlighting the importance of hospital culture and clinician attitudes in influencing medical practice.
Article Abstract
Background: Cesarean delivery rates in the United States vary widely between hospitals, which cannot be fully explained by hospital or patient factors. Cultural factors are hypothesized to play a role in cesarean overuse, yet tools to measure labor culture are lacking. The aim of this study was to revise and validate a survey tool to measure hospital culture specific to cesarean overuse.
Methods: A panel of clinicians and researchers compiled an item bank from validated surveys, added newly created items, and performed four rounds of iterative revision and consolidation. Obstetricians, family physicians, midwives, anesthesiologists, and labor nurses were recruited from 79 hospitals in California. Exploratory factor analysis was used to reduce the number of survey items and identify latent constructs to form the basis of subscales. Confirmatory factor analysis examined reliability in 31 additional hospitals. Poisson regression assessed associations between hospitals' mean score on each individual item and cesarean rates.
Results: A total of 1718 individuals from 70 hospitals were included in the exploratory factor analysis. The final Labor Culture Survey (LCS) consisted of 29 items and six subscales: "Best Practices to Reduce Cesarean Overuse," "Fear of Vaginal Birth," "Unit Microculture," "Physician Oversight," "Maternal Agency," and "Cesarean Safety."
Conclusions: The revised LCS is a valid and reliable tool to measure constructs shown to be associated with cesarean rates. These findings support prior research that has shown that hospital culture is measurable, and that clinician attitudes are predictive of clinician behaviors. Unique to our survey is the construct of labor and delivery unit microculture.
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| http://dx.doi.org/10.1111/birt.12406 | DOI Listing |
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