医院分娩量和旅行时间对围产死亡率和过境分娩的影响:因果推理与三角测量
Andreas Asheim1,2, Sara Marie Nilsen1,3, Signe Opdahl4
1From the Center for Health Care Improvement, St. Olav's University Hospital, Trondheim, Norway.
Epidemiology (Cambridge, Mass.)
|January 28, 2025
概括
容量较大的医院可能会改善围产期的结果. 这项研究发现,虽然初步分析表明,高体积医院的死亡率更高,但兄弟姐妹和邻居的比较表明相反,表明增加获得高体积护理的好处.
科学领域:
- 围产期健康 围产期健康
- 获得医疗保健 获得医疗保健 获得医疗保健
- 流行病学 流行病学
背景情况:
- 医院区域化旨在平衡患者获取和医院容量.
- 了解医院体积和旅行时间对围产期结果的影响对于优化护理至关重要.
研究的目的:
- 调查医院体积和旅行时间对围产死亡率和过境分娩的影响.
- 将三种不同的研究设计中的发现进行比较,以评估结论的可靠性.
主要方法:
- 全国范围的队列研究使用挪威出生登记数据 (1999-2016).
- 采用了三个分析设计:观察到混调整,兄弟比较和邻居比较.
- 分析了来自不同医院采集区的100多万名分娩的数据.
主要成果:
- 观察到的混因素调整表明,在大量医院中,产后死亡率更高 (2000年与每年500例分娩相比).
- 兄弟姐妹和邻居的比较表明,在体积较大的医院中,围产期死亡率显著降低.
- 旅行时间的增加与更高的围产死亡率和运输中分娩风险的增加有关.
结论:
- 调整观察到的混因素的初步分析不足以捕捉住医院体积和围产死亡率之间的真正关系.
- 来自多个设计的结果的三角分析表明,进入更大体积的医院可能会改善围产期的结果.
- 调查结果支持围产期护理的区域化,以向更大容量的设施,以提高人口水平的结果.
相关概念视频
Causality in Epidemiology
275
Causality or causation is a fundamental concept in epidemiology, vital for understanding the relationships between various factors and health outcomes. Despite its importance, there's no single, universally accepted definition of causality within the discipline. Drawing from a systematic review, causality in epidemiology encompasses several definitions, including production, necessary and sufficient, sufficient-component, counterfactual, and probabilistic models. Each has its strengths and...
275
Regression Toward the Mean
6.3K
Regression toward the mean (“RTM”) is a phenomenon in which extremely high or low values—for example, and individual’s blood pressure at a particular moment—appear closer to a group’s average upon remeasuring. Although this statistical peculiarity is the result of random error and chance, it has been problematic across various medical, scientific, financial and psychological applications. In particular, RTM, if not taken into account, can interfere when...
6.3K
Methods of Documentation VI: Case Management Model
559
The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
For example, a patient with a chronic...
For example, a patient with a chronic...
559
Hazard Ratio
79
The hazard ratio (HR) is a widely used measure in clinical trials to compare the risk of events, such as death or disease recurrence, between two groups over time. It reflects the ratio of hazard rates—the instantaneous risk of the event occurring—between a treatment group and a control group. This measure provides valuable insights into the relative effectiveness of a treatment by assessing how the risk of an event differs between the two groups.
For example, in a clinical trial...
For example, in a clinical trial...
79
Methods Of Healthcare Delivery System
3.1K
At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
3.1K
Confounding in Epidemiological Studies
135
Confounding in statistical epidemiology represents a pivotal challenge, referring to the distortion in the perceived relationship between an exposure and an outcome due to the presence of a third variable, known as a confounder. This variable is associated with both the exposure and the outcome but is not a direct link in their causal chain. Its presence can lead to erroneous interpretations of the exposure's effect, either exaggerating or underestimating the true association. This...
135


