Differences in the Quality of Care and Resulting Outcomes in Childbirth between Family Physicians and Obstetricians: Comparison of a Matched Cohort
Bibliographic record
Abstract
Background: The literature on clinical management of childbirth in women with low obstetrical risk shows that family physicians (FPs) practice differently from obstetricians. Whether these differences persist when high obstetrical risk patients are included is unknown. Methodological concerns regarding selection bias and small sample size limits the validity and generalizeability of the individual studies. Objectives: To determine whether practice patterns and outcomes for maternity patients in BC at three levels of risk differs according to physician specialty. Methodology: We extracted maternity data on all deliveries in 17 acute care hospitals in British Columbia (BC) over a one year period. Patients were classified as being under the care of FP or obstetricians based on initial admission and were then matched according to their propensity score that were estimated according to demographics, hospital information and diagnosis-related variables. Patient risk level was classified based on specific diagnostic criteria at admission. We compared the rates of intervention, delivery method and maternal outcomes between patients in the matched cohort. In addition, multivariate logistic regression was used to estimate the difference in the odds of hospital readmission between the two groups within 60 days after being discharged from the hospital. Results: Out of 23,038 patients in 1993, 12,490 were matched according to their propensity score; half of the patients were cared for by FPs and the other half by obstetricians. During intrapartum care, women managed by FPs were more likely to have artificial rupture membranes (38% vs. 32%, p Conclusions: Our results confirmed findings from previous studies that FPs used more spontaneous vaginal delivery, and obstetricians used more cesarean delivery. However, our study showed that instead of using less procedures, FPs performed more procedures than obstetricians once high obstetric risk patients were included and maternal outcomes in the FP group were worse with regard to perineal tear and postpartum hemorrhage. In terms of readmission, there were no significant differences between the two groups.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".