Reducing the rate of cesarean delivery on maternal request through institutional and policy interventions in Wenzhou, China.
Reducing the rate of cesarean delivery on maternal request through institutional and policy interventions in Wenzhou, China.
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中国温州通过制度和政策干预降低产妇要求的剖腹产率
DOI：
10.1371/journal.pone.0186304
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Chen C
中科院分区：
文献类型：
--
作者：
Yu Y;Zhang X;Sun C;Zhou H;Zhang Q;Chen C
本研究的目的是评估制度和政策干预措施对降低温州市应产妇要求剖宫产率（CDMR）的影响。机构干预措施包括健康教育、无痛分娩介绍和导乐护理。此外，中国中央和地方政府制定了一系列卫生政策来控制剖宫产率，主要是通过控制CDMR率。我们对2006年至2014年期间在中国温州三家三级公立医院分娩的131，312名产妇进行了干预前/后研究。卡方检验和预测模型被用来检查之前和之后的制度和政策干预的CDMR率的变化。在引入机构干预后，总体CDMR率从15.76%上升到16.34%（p = 0.053），但总体CDMR率的平均年增长率（AAGR）迅速从20.11%下降到-4.30%。政策干预后，整体CDMR率，整体CDMR率的AAGR，和执行CDMR的概率下降。此外，在机构和政策干预后，所有三个年龄组（第一组：<24岁;第二组：24-34岁;第三组：>34岁）妇女接受CDMR的总体概率都有所下降。这些结果表明，制度和政策干预可以降低CDMR率。此外，应将CDMR率纳入医院绩效评估矩阵，以进一步降低CDMR率。
The objective of this study was to evaluate the effect of institutional and policy interventions on reducing the rate of cesarean delivery on maternal request (CDMR) in Wenzhou, China. Institutional interventions included health education, painless delivery introduction, and doula care. Additionally, a series of health policies were developed by the Chinese central and local governments to control cesarean section rates, mostly through controlling CDMR rates. We conducted a pre-/post-intervention study using 131,312 deliveries between 2006 and 2014 in three tertiary-level public hospitals in Wenzhou, China. Chi-square tests and predictive models were used to examine changes in the CDMR rate before and after institutional and policy interventions. After institutional interventions were introduced, the overall CDMR rate increased from 15.76% to 16.34% (p = 0.053), but the average annual growth rate (AAGR) of the overall CDMR rate quickly declined from 20.11% to -4.30%. After policy interventions were introduced, the overall CDMR rate, the AAGR of the overall CDMR rate, and the probability of performing CDMR declined. Further, the overall probability of a woman undergoing CDMR decreased in all three age groups (group one: <24; group two: 24–34; group three: >34) after institutional and policy interventions. These results show that institutional and policy interventions can reduce the CDMR rate. Additionally, the CDMR rate should be included in hospitals’ performance assessment matrix to reduce the CDMR rate further.
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