医院级产科质量指标与母亲和新生儿发病率之间的关联
Elizabeth A Howell1, Jennifer Zeitlin2, Paul L Hebert3
1Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York2Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York.
JAMA
|October 17, 2014
概括
这项研究发现,常见的产科质量指标与母亲或新生儿并发症之间没有联系. 目前的质量措施可能无法完全捕捉产科护理的改善.
科学领域:
- 产科和妇科 产科和妇科
- 孕产妇和胎儿医学 孕产妇和胎儿医学
- 改善医疗保健质量 改善医疗保健质量
背景情况:
- 公开报告产科质量措施的目的是改善护理.
- 这些质量指标与实际的孕产妇/新生儿死亡率之间的关联还不清楚.
研究的目的:
- 调查两个联合委员会产科质量指标是否与孕产妇和新生儿发病率相关.
主要方法:
- 基于人口的观察性研究,使用纽约市相关的出生和出院数据 (2010年).
- 在低风险的母亲中,选择性早产和剖腹产的计算率.
- 使用已建立的算法识别了严重的孕产妇和新生儿发病率.
- 雇佣混合效应物流回归,调整为患者和医院的因素.
主要成果:
- 在2.4%的分娩中发生严重的孕产妇发病率;新生儿发病率在7.8%的新生儿中发生.
- 医院间选择性早产率 (15.5-41.9%) 和低风险剖腹产率 (11.7-39.3%) 的差异很大.
- 这些质量指标与严重的孕产妇或新生儿发病率之间没有发现统计学意义上的关联.
结论:
- 在各医院中观察到产科质量指标率和并发症率的巨大差异.
- 目前的质量指标 (选择性早产,低风险剖腹产) 似乎与孕产妇或新生儿发病率无关.
- 现有的质量措施可能不足以有效指导产科护理质量改善.
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