Outcomes, safety, and resource utilization in a collaborative care birth center program compared with traditional physician-based perinatal care
Outcomes, safety, and resource utilization in a collaborative care birth center program compared with traditional physician-based perinatal care
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DOI：
10.2105/ajph.93.6.999
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发表时间：
2003-06-01
影响因子：
12.7
通讯作者：
Nguyen, U
中科院分区：
文献类型：
--
作者：
Jackson, DJ;Lang, JM;Nguyen, U
Objective.我们比较了围产期护理的协作管理分娩中心模式与传统的以医生为基础的护理的结局、安全性和资源利用。我们研究了2957名低风险、低收入的妇女：1808名接受协作护理，1149名接受传统护理。产前大出血（校正的风险差异[RD]=-0.5%; 95%置信区间[Cl]=-2.5，1.5），产时（校正RD=0.8%; 95% CI =-2.4，4.0），新生儿（调整后的RD=-1.8%，95%CI =-3.8，0.1）并发症相似，新生儿重症监护病房入院率也相似（调整后的RD=-1.3%，95%CI =-3.8，1.1）。协作护理组的自然阴道分娩率较高（校正后的RD = 14.9%; 95%CI = 11.5，18.3），硬膜外麻醉使用率较低（校正后的RD=-35.7%至95%CI =-39.5，-31.8）。对于低风险妇女，这两种情况都能为母亲和婴儿带来安全的结果。然而，协作护理中使用的手术分娩和医疗资源较少。
Objective. We compared outcomes, safety, and resource utilization in a collaborative management birth center model of perinatal care versus traditional physician-based care.Methods. We studied 2957 low-risk, low-income women: 1808 receiving collaborative care and 1149 receiving traditional care.Results. Major antepartum (adjusted risk difference [RD]=-0.5%; 95% confidence interval [Cl]=-2.5, 1.5), intrapartum (adjusted RD=0.8%; 95% Cl =-2.4, 4.0), and neonatal (adjusted RD=-1.8%; 95% Cl=-3.8, 0.1) complications were similar, as were neonatal intensive care unit admissions (adjusted RD=-1.3%; 95%CI=-3.8, 1.1). Collaborative care had a greater number of normal spontaneous vaginal deliveries (adjusted RD = 14.9%; 95% Cl = 11.5, 18.3) and less use of epidural anesthesia (adjusted RD=-35.7%;95%CI=-39.5,-31.8).Conclusions. For low-risk women, both scenarios result in safe outcomes for mothers and babies. However, fewer operative deliveries and medical resources were used in collaborative care.