Dataset Information

Practice variation, bias, and experiential learning in cesarean delivery: a data-based system dynamics approach.

ABSTRACT:

Objectives

To simulate physician-driven dynamics of delivery mode decisions (scheduled cesarean delivery [CD] vs. vaginal delivery [VD] vs. unplanned CD after labor), and to evaluate a behavioral theory of how experiential learning leads to emerging bias toward more CD and practice variation across obstetricians.

Data sources/study setting

Hospital discharge data on deliveries performed by 300 randomly selected obstetricians in Florida who finished obstetrics residency and started practice after 1991.

Study design

We develop a system dynamics simulation model of obstetricians' delivery mode decision based on the literature of experiential learning. We calibrate the model and investigate the extent to which the model replicates the data.

Principal findings

Our learning-based simulation model replicates the empirical data, showing that physicians are more likely to schedule CD as they practice longer. Variation in CD rates is related to the way that physicians learn from outcomes of past decisions and accumulate experience.

Conclusions

The repetitive nature of medical decision making, learning from past practice, and accumulating experience can account for increases in CD decisions and practice variation across physicians. Policies aimed at improving medical decision making should account for providers' feedback-based learning mechanisms.

SUBMITTER: Ghaffarzadegan N

PROVIDER: S-EPMC3626332 | biostudies-literature | 2013 Apr

REPOSITORIES: biostudies-literature

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Publications

Practice variation, bias, and experiential learning in cesarean delivery: a data-based system dynamics approach.

Ghaffarzadegan Navid N Epstein Andrew J AJ Martin Erika G EG

Health services research 20130210 2 Pt 2

<h4>Objectives</h4>To simulate physician-driven dynamics of delivery mode decisions (scheduled cesarean delivery [CD] vs. vaginal delivery [VD] vs. unplanned CD after labor), and to evaluate a behavioral theory of how experiential learning leads to emerging bias toward more CD and practice variation across obstetricians.<h4>Data sources/study setting</h4>Hospital discharge data on deliveries performed by 300 randomly selected obstetricians in Florida who finished obstetrics residency and started ...[more]

PMID: 23398502

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Dataset Information

Practice variation, bias, and experiential learning in cesarean delivery: a data-based system dynamics approach.

Objectives

Data sources/study setting

Study design

Principal findings

Conclusions

Publications

Practice variation, bias, and experiential learning in cesarean delivery: a data-based system dynamics approach.

Similar Datasets

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