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To examine the extent of hospital‐level variation in risk‐adjusted rates of postpartum hemorrhage (PPH).

We performed a cross‐sectional study examining live births in 257 California hospitals between 2011 and 2015 using linked birth certificate and maternal discharge data. PPH was measured using International Classification of Diseases Codes version 9. Mixed‐effects logistic regression models were used to examine the presence and extent of hospital‐level variation in PPH before and after adjustment for patient‐level risk factors and select hospital characteristics (teaching status and annual delivery volume). Risk‐adjusted rates of PPH were estimated for each hospital. The extent of hospital variation was evaluated using the median odds ratio (MOR) and intraclass correlation coefficient (ICC).

Our study cohort comprised 1,904,479 women who had a live …