Effects of a Multi-site Expansion of Group Prenatal Care on Birth Outcomes
Effects of a Multi-site Expansion of Group Prenatal Care on Birth Outcomes
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DOI：
10.1007/s10995-019-02795-4
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发表时间：
2019-10-01
影响因子：
2.3
通讯作者：
Willis, Carla
中科院分区：
文献类型：
--
作者：
Crockett, Amy H.;Heberlein, Emily C.;Willis, Carla
围产期质量合作在美国各地发起的项目，以改善妇女和婴儿的健康和医疗保健。我们比较了一个循证小组产前护理模式，以通常的个人产前护理的出生结果，在一个多站点扩展组产前护理支持的全州多学科围产期质量协作。方法我们使用偏好群内匹配倾向评分法和logistic回归分析了南卡罗来纳州（2013-2017年）13个医疗机构中15，330名年龄在14-48岁的孕妇。结果从出生证明数据中提取。我们比较了（a）意向治疗水平的妇女和（B）参加至少5次产前检查的妇女与参加少于5次产前检查的妇女的结局。结果在意向治疗分析中，接受团体产前护理的妇女早产的可能性显着降低（绝对风险差异-3.2%，95% CI - 5.3至-1.0%），低出生体重儿（绝对风险差异-3.7%，95% CI-5.5至-1.8%）和NICU入院（绝对风险差异-4.0%，95% CI-5.6至-2.3%）。在实际治疗分析中，与意向治疗分析相比，妇女在早产和低出生体重结局方面有更大的改善。实践中心的结论妊娠组产前护理是有效的，在一系列的现实世界的临床实践，降低早产和低出生体重的风险。这是一个可行的方法，其他围产期质量合作，试图在他们不断努力改善孕产妇和婴儿的健康结果。
Objectives Perinatal Quality Collaboratives across the United States are initiating projects to improve health and healthcare for women and infants. We compared an evidence-based group prenatal care model to usual individual prenatal care on birth outcomes in a multi-site expansion of group prenatal care supported by a state-wide multidisciplinary Perinatal Quality Collaborative. Methods We analyzed 15,330 pregnant women aged 14-48 across 13 healthcare practices in South Carolina (2013-2017) using a preferential-within cluster matching propensity score method and logistic regression. Outcomes were extracted from birth certificate data. We compared outcomes for (a) women at the intent-to-treat level and (b) for women participating in at least five group prenatal care visits to women with less than five group visits with at least five prenatal visits total. Results In the intent-to-treat analyses, women who received group prenatal care were significantly less likely to have preterm births (absolute risk difference - 3.2%, 95% CI - 5.3 to - 1.0%), low birth weight births (absolute risk difference - 3.7%, 95% CI - 5.5 to - 1.8%) and NICU admissions (absolute risk difference - 4.0%, 95% CI - 5.6 to - 2.3%). In the as-treated analyses, women had greater improvements compared to intent-to-treat analyses in preterm birth and low birth weight outcomes. Conclusions for Practice CenteringPregnancy group prenatal care is effective across a range of real-world clinical practices for decreasing the risk of preterm birth and low birth weight. This is a feasible approach for other Perinatal Quality Collaboratives to attempt in their ongoing efforts at improving maternal and infant health outcomes.