在商业保险患者群体中,评估产前护理利用率与产科结果之间的风险调整关联
Adina R Kern-Goldberger1,2, Natalie E Sheils3, Rachell Vinculado3
1Division of Maternal-Fetal Medicine, Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
American journal of perinatology
|March 17, 2025
概括
定期的产前护理访问并没有防止严重的孕产妇发病率或死产. 增加产前护理与更高的早产率有关,这表明人们寻求有关症状的护理,而不仅仅是例行检查.
科学领域:
- 产科和妇科 产科和妇科
- 孕产妇健康 孕产妇健康
- 公共卫生 公共卫生
背景情况:
- 一个世纪以来,传统的办公室产前护理一直保持不变.
- 常规产前检查对母亲主要不良结果的影响尚不清楚.
- 这项研究调查了产前护理利用和不良产科结果之间的关联.
研究的目的:
- 检查产前护理利用率与严重孕产妇发病率 (SMM),早产和死产之间的关系.
- 评估产前护理的数量是否会影响这些不良的产科结果.
- 为改善临床质量和健康政策提供有关产前护理指标的信息.
主要方法:
- 使用美国大型保险索赔数据库 (2017-2020) 进行的回顾性队列研究.
- 产前护理利用率使用产前护理利用率充分性指数 (APNCU) 进行评估.
- 后勤回归模型用于分析由OB-CMI得分定义的低风险和中等风险母亲群体的护理水平和结果之间的关联.
主要成果:
- 在产前护理量与严重的孕产妇发病率或死产之间没有发现统计学意义上的关联.
- 过早分娩 (<37周) 在低风险和中等风险组中显示出与"充足"和"充足加"护理的积极关联.
- "不充分"的产前护理与任何研究的不良结果都没有关联.
- 总共有297,453名患者被纳入分析.
结论:
- 总体而言,产前护理的总量并没有显示出严重的孕产妇发病率或死产的减少.
- 研究结果表明,目前的产前护理指导方针可能需要修订,重点关注参观人数.
- 未来的努力应该优先考虑临床结果,而不是遵守基于访问的指标,以改善产前护理.
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