The quality of maternity care services as experienced by women in the Netherlands.
The quality of maternity care services as experienced by women in the Netherlands.
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DOI：
10.1186/1471-2393-9-18
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发表时间：
2009-05-09
影响因子：
3.1
通讯作者：
Wiegers TA
中科院分区：
文献类型：
--
作者：
Wiegers TA
产妇护理是指与怀孕、分娩和产后有关的所有护理。在荷兰，产妇护理由初级护理中的助产士和全科医生 (GP) 以及二级护理中的助产士和妇科医生提供。为了能够解释妇女对产妇护理质量的体验，有必要考虑她们的“护理路径”，即：她们通过护理系统的路线。荷兰正在开发一种新工具，可以从客户的角度评估护理质量。该工具被称为“消费者质量指数”或 CQI，在标准化和系统框架内针对特定的医疗保健问题量身定制。在制定 CQI 产妇护理的框架内，收集了荷兰妇女在怀孕、分娩和产后期间接受的护理的数据。本文介绍了荷兰产妇护理的质量，以及妇女在护理过程的不同阶段所经历的情况。四家保险公司的 1,248 名怀孕客户样本（预产期为 2007 年 4 月上旬）收到了妊娠晚期的邮政调查（答复 793）。第一份问卷的答复者在十二周后（平均分娩后四个星期）收到第二份问卷（答复 632）。根据护理提供者和出生地点描述了妇女的“护理路径”。通过因子分析和可靠性分析，构建了五个综合指标，表明护理人员在护理路径不同阶段的治疗质量。总体评级涉及八个不同的护理方面，从助产士或全科医生的产前护理到与新生儿筛查相关的护理。 41.5%的受访者在整个怀孕、临产、分娩和产后期间一直接受初级保健，接受助产士或全科医生的护理，31.3%的受访者在家中分娩。大多数女性（58.5%）至少经历过一次从一个护理提供者转介到另一个护理提供者，即从初级护理转至二级护理或反向转诊。除百分之二之外，所有女性在怀孕期间都接受过一次或多次超声波扫描。对不同环境和不同护理提供者的治疗质量的综合衡量表明，无论产次如何，妇女对她们所接受的产妇护理质量都非常积极。治疗质量得分很高：从 1 到 4 分，平均得分为 3.75。产前、临产、分娩和产后期护理质量的 0-10 分总体评分也很高，平均为 8.36。妇女在产科护理方面的护理之路很少是直截了当的。大多数孕妇在怀孕期间或分娩和分娩期间或两者期间至少从初级护理转向二级护理并返回至少一次。质量衡量结果表明，整个护理系统中妇女所经历的护理质量很高。但就分娩和分娩期间的护理而言，当妇女认识自己的护理提供者、在家分娩、在初级护理机构分娩以及由自己的助产士协助时，护理质量得分会更高。
Maternity care is all care in relation to pregnancy, childbirth and the postpartum period. In the Netherlands maternity care is provided by midwives and general practitioners (GPs) in primary care and midwives and gynecologists in secondary care. To be able to interpret women's experience with the quality of maternity care, it is necessary to take into account their 'care path', that is: their route through the care system. In the Netherlands a new tool is being developed to evaluate the quality of care from the perspective of clients. The tool is called: 'Consumer Quality Index' or CQI and is, within a standardized and systematic framework, tailored to specific health care issues. Within the framework of developing a CQI Maternity Care, data were gathered about the care women in the Netherlands received during pregnancy, childbirth, and the postpartum period. In this paper the quality of maternity care in the Netherlands is presented, as experienced by women at different stages of their care path. A sample of 1,248 pregnant clients of four insurance companies, with their due date in early April 2007, received a postal survey in the third trimester of pregnancy (response 793). Responders to the first questionnaire received a second questionnaire twelve weeks later, on average four weeks after delivery (response 632). Based on care provider and place of birth the 'care path' of the women is described. With factor analysis and reliability analysis five composite measures indicating the quality of treatment by the care provider at different stages of the care path have been constructed. Overall ratings relate to eight different aspects of care, varying from antenatal care by a midwife or GP to care related to neonatal screening. 41.5 percent of respondents remained in primary care throughout pregnancy, labor, birth and the postpartum period, receiving care from a midwife or general practitioner, 31.3% of respondents gave birth at home. The majority of women (58.5%) experienced referral from one care provider to another, i.e. from primary to secondary care or reverse, at least once. All but two percent of women had one or more ultrasound scans during pregnancy. The composite measures for the quality of treatment in different settings and by different care providers showed that women, regardless of parity, were very positive about the quality of the maternity care they received. Quality-of-treatment scores were high: on average 3.75 on a scale ranging from 1 to 4. Overall ratings on a 0 – 10 scale for quality of care during the antenatal period and during labor, birth and the postpartum period were high as well, on average 8.36. The care path of women in maternity care was seldom straight forward. The majority of pregnant women switched from primary to secondary care and back at least once, during pregnancy or during labor and birth or both. The results of the quality measures indicate that the quality of care as experienced by women is high throughout the care system. But with regard to the care during labor and birth the quality of care scores are higher when women know their care provider, when they give birth at home, when they give birth in primary care and when they are assisted by their own midwife.
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