Cesarean birth rate: small-geographic-area analysis.

Population-based analysis of cesarean section rates within 172 geographic areas in the Commonwealth of Massachusetts during fiscal year 1985 revealed a nearly normal distribution of observed-to-expected rates, implying that the forces that compel obstetricians to perform this surgical procedure are pervasive. However, a small number of areas were identified in which the number of procedures performed was significantly different from the state mean. During fiscal years 1982 to 1985, certain geographic subgroups consistently demonstrated incidence rates significantly greater than the state mean. Although variation (either overutilization or underutilization) from the state rate is not synonymous with inappropriate care, those physicians within the identified geographic areas must take responsibility for ascertaining the explanation for the variance.

Report on variation in rates of utilization of surgical services in the Commonwealth of Massachusetts.

This article presents an analysis of over 140,000 selected surgical procedures performed in Massachusetts in 1980, giving the per capita rates of 14 common procedures and of four less frequently performed procedures. The analysis defines 172 geographic areas for the commonly performed procedures and 45 for the less frequently performed procedures. Per capita surgical rates among the defined areas are significantly different from both a statistical and a clinical point of view. Twofold and threefold variations occur frequently across geographic areas. In certain areas, some surgical services appear to be provided at rates substantially different from the statewide rate. We discuss the importance of these data for physicians as well as the implications for the distribution and quality of clinical care and for containment of medical care costs.

The closure of maternity services in Massachusetts. The causes, process, and hospital impact.

There has been a decline in the number of maternity services in Massachusetts from 120 in 1960 to 65 in 1975. Further consolidation must be carefully thought out with all options and possible outcomes thoroughly explored. The Massachusetts Maternity and Newborn Regionalization Project and the Massachusetts Hospital Association conducted a preliminary survey of Massachusetts Maternity services that had closed to understand the causes, process,, and hospital impact. The findings of this preliminary investigation, in addition to identifying areas for more intensive future research, provide some observations that should be of assistance to those considering a maternity service closure.