Evaluation of the quality of care for severe obstetrical haemorrhage in three French regions
Evaluation of the quality of care for severe obstetrical haemorrhage in three French regions
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DOI：
10.1111/j.1471-0528.2001.00224.x
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发表时间：
2001-09-01
期刊：
影响因子：
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通讯作者：
Palot, M
中科院分区：
文献类型：
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作者：
Bouvier-Colle, MH;El Joud, DO;Palot, M
目的 确定与法国卫生服务相关的哪些因素可能解释产科出血严重发病率的不合格护理。设计回顾性问卷调查。设置法国的三个行政区域。人口所有在调查前一年内怀孕或最近分娩的妇女。方法欧洲调查 (MOMS-B) 将严重出血定义为失血量大于或等于 1500mL。法国增加了一份具体的调查问卷来分析这些出血的护理质量。该调查在三个不同的行政区进行：香槟-阿登、中部和洛林，任命了一个专家委员会，并开始建立定性评估框架。对一百六十五例严重出血病例进行了审查，并将其分为三个护理级别之一：适当、不充分或混合。护理不足和“混合”护理都被认为是不合格的。对 165 例病例进行编码，然后进行单变量和多变量分析（使用 SAS 和 SPSS 软件进行逻辑回归）。结果 在确定的 165 例病例中，51% (85/165) 是阴道手术，19% (31/165) 是阴道手术，30% (49/165) 是剖腹产。出血的主要原因是子宫收缩乏力。总体而言，62% 的病例得到了适当的护理，24% 的病例得到了完全不充分的护理，14% 的病例得到了混合护理。在对社会人口统计因素、产前护理和组织方面进行调整后，医院缺乏 24 小时现场麻醉师和分娩量低（每年< 500 名新生儿）是与护理不合格相关的因素。 结论 组织特征非常重要，应用良好的临床实践来实现更安全的孕产，加强了对新的产科服务组织的需求。首次证明麻醉师的存在对女性分娩的护理质量具有可衡量的影响。这些结果需要得到其他人的证实。
Objective To determine what factors related to health services in France might explain substandard care of severe morbidity due to obstetric haemorrhage.Design Retrospective questionnaire survey.Setting Three administrative regions of France.Population All women who were pregnant or had recently given birth during the year before the survey.Methods A European survey (MOMS-B) defined severe haemorrhages as blood loss greater than or equal to 1500mL. A specific questionnaire was added in France to analyse the quality of care of these haemorrhages. The survey was carried out in three different administrative regions: Champagne-Ardenne, the Centre and Lorraine, An expert committee was appointed and began by establishing a framework for qualitative assessment. One hundred and sixty-five cases of severe haemorrhage were reviewed and classified into one of three levels of care: appropriate, inadequate or mixed. Inadequate care and 'mixed' care were both considered substandard. The 165 cases were coded and then studied with uni- and multivariate analysis (logistic regression with SAS and SPSS software).Results Of the 165 cases identified, 51 % (85/165) were vaginal, 19% (31/165) operative vaginal, and 30% (49/165) caesarean. The leading cause of haemorrhage was uterine atony. Overall, 62% of the cases received appropriate care, 24% received totally inadequate care and 14% mixed care. After adjustment for sociodemographic factors, antenatal care and organisational aspects, the lack of a 24-hour on-site anaesthetist at the hospital and a low volume of deliveries (< 500 births per year) were the factors associated with substandard care.Conclusion Organisational features are so important that application of good clinical practices for safer motherhood reinforce the need for new organisation of obstetric services. For the first time, the presence of an anaesthetist is shown to have a measurable effect on the quality of care for women giving birth. These results need to be confirmed by others.