Initial development of a system-wide maternal-fetal outcomes assessment program
Initial development of a system-wide maternal-fetal outcomes assessment program
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DOI：
10.1067/mob.2000.108087
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发表时间：
2000-08-01
影响因子：
9.8
通讯作者：
Ferguson, JE
中科院分区：
文献类型：
--
作者：
Novicoff, WM;Wagner, DP;Ferguson, JE
目的：本研究旨在开发一种能够评估母体和胎儿结局的综合风险评估方法。研究设计：从1995年到1997年，来自美国79个军事治疗机构的10984名妇女和11066名婴儿的数据被用来建立两种单独但互补的风险调整模型，分别用于母体和胎儿的结局。一系列与产妇和分娩相关的风险变量和临床重要结果由专家意见确定，并通过有序逻辑回归分析进行选择和加权。确定了母体和胎儿模型的受试者工作特征曲线。还评估了各设施在风险调整绩效方面的差异。结果：母亲和婴儿的危险因素和不良结局都很少见，96.9%的婴儿和97.7%的母亲有良好或极好的结局（死亡率分别为0.7%和0.01%）。尽管不良结局的频率较低，但两种模型都表现良好，产妇结局的受试者工作特征曲线为0.75，婴儿结局的受试者工作特征曲线为0.78。当模型应用于军队医疗设施时，各设施的风险调整结果存在显著差异。研究中有24家（30%）的结果优势比显著为bb0.1或显著
OBJECTIVE: This study was undertaken to develop a comprehensive risk-assessment approach capable of evaluating maternal and fetal outcomes.STUDY DESIGN: Data from 10,984 women and 11,066 infants delivered at 79 military treatment facilities in the United States from 1995 to 1997 were used to develop two individual but complementary risk-adjustment models for maternal and, separately, fetal outcomes. A range of maternal and delivery-related risk variables and clinically important outcomes were identified by expert opinion and selected and weighted with ordinal logistic regression analysis. Receiver operating characteristic curves for the maternal and fetal models were determined. Variation across the facilities in risk-adjusted performance was also evaluated.RESULTS: Risk factors and poor outcomes were rare for both mothers and infants, with 96.9% of infants and 97.7% of mothers having good or excellent outcomes (0.7% mortality and 0.01% mortality, respectively). Despite the low frequency of poor outcomes both models performed well, with receiver operating characteristic curves of 0.75 for maternal outcomes and 0.78 for infant outcomes. When the models were applied to the military treatment facilities, there were significant differences among facilities in risk-adjusted outcomes. Twenty-four of the facilities in the study (30%) had outcomes odds ratios that were significantly >1 or significantly