Can differences in obstetric outcomes be explained by differences in the care provided? The MFMU Network APEX study
Can differences in obstetric outcomes be explained by differences in the care provided? The MFMU Network APEX study
复制标题
DOI：
10.1016/j.ajog.2014.03.017
复制
发表时间：
2014-08-01
影响因子：
9.8
通讯作者：
Van Dorsten, J. Peter
中科院分区：
文献类型：
--
作者：
Grobman, William A.;Bailit, Jennifer L.;Van Dorsten, J. Peter
目的：本研究的目的是确定医院产科不良结局发生率的差异是否与护理的差异有关。研究设计：围产期优生评估队列包括2008年3月至2011年2月期间在美国25家医院出生的115,502名妇女及其新生儿。分层逻辑回归用于量化医院间产后出血、围产期感染、严重会阴撕裂伤和新生儿复合不良结局的变异量，这些变异可由患者特征、医院特征和产科护理的差异来解释。结果：该研究包括115,502名女性。对于大多数结果，20-40%的医院结果差异与患者群体差异有关。在调整了患者、提供者和医院水平的因素后，多个护理过程与预先确定的不良结果相关；然而，这些护理过程并不能解释医院间不良结果发生频率的显著差异。最终，50-100%的医院间结果差异是无法解释的。结论：医院产科不良结局发生频率的差异不能用所提供护理类型频率的差异来解释。
OBJECTIVE: The purpose of this study was to determine whether hospital differences in the frequency of adverse obstetric outcomes are related to differences in care.STUDY DESIGN: The Assessment of Perinatal EXcellence cohort comprises 115,502 women and their neonates who were born in 25 hospitals in the United States between March 2008 and February 2011. Hierarchical logistic regression was used to quantify the amount of variation in postpartum hemorrhage, peripartum infection, severe perineal laceration, and a composite adverse neonatal outcome among hospitals that is explained by differences in patient characteristics, hospital characteristics, and obstetric care provided.RESULTS: The study included 115,502 women. For most outcomes, 20-40% of hospital differences in outcomes were related to differences in patient populations. After adjusting for patient-, provider-, and hospital-level factors, multiple care processes were associated with the predefined adverse outcomes; however, these care processes did not explain significant variation in the frequency of adverse outcomes among hospitals. Ultimately, 50-100% of the interhospital variation in outcomes was unexplained.CONCLUSION: Hospital differences in the frequency of adverse obstetric outcomes could not be explained by differences in frequency of types of care provided.