Practice audits to reduce caesareans in a tertiary referral hospital in south-western China
Practice audits to reduce caesareans in a tertiary referral hospital in south-western China
复制标题
中国西南部一家三级转诊医院开展审计以减少剖腹产
DOI：
10.2471/blt.11.093369
复制
发表时间：
2012-07-01
期刊：
影响因子：
--
通讯作者：
Dandan, Zhang
中科院分区：
文献类型：
--
作者：
Runmei, Ma;Terence T, Lao;Dandan, Zhang
目的评价我国某三级医院降低剖宫产率的三阶段干预措施的效果。方法采用回顾性研究的方法，对2005年开始实施的教育职工、教育病人和审计外科医生行为是否降低了剖宫产率进行了研究。用多元Logistic回归分析剖宫产率和新生儿重症监护病房(NICU)的住院率之间的关系。结果：2001-2004年的剖宫产率为53.5%-56.1%，2005-2011年为43.9%-36.1%。当将2001年至2004年和2005年至2011年作为评估干预措施对平均剖宫产率影响的“前”和“后”时期时，显著降低：从54.8%降至40.3%(优势比OR：0.5695%可信区间CI：0.520.59；X-2检验：P<；0.001)。剖腹产率总体下降非常显著(X-2检验：P<；0.001)，并且与年份呈负相关(Spearman‘s p：-0.096；P<；0.001)。尽管2004年后复杂妊娠有所增加，但在实施实践审计后，2005-2011年初次剖腹产率平均每年下降20%。多因素Logistic回归分析显示，剖宫产率与NICU入院率呈正相关(调整后OR：1.26；95%CI：1.14~1.40)。结论在不增加NICU入院率的情况下，患者和工作人员的教育和实践审计降低了三级转诊医院的剖腹产率。
Objective To assess the effectiveness of a three-stage intervention to reduce caesarean deliveries in a Chinese tertiary hospital.Methods A retrospective study was conducted to assess whether educating staff, educating patients and auditing surgeon practices (introduced in 2005) had reduced caesarean delivery rates. Multiple logistic regression was used to check for a potential association between caesarean rates and rates of admission to the neonatal intensive care unit (NICU).:Findings The caesarean delivery rate ranged from 53.5% to 56.1% in 2001-2004 and from 43.9% to 36.1% in 2005-2011. When 2001-2004 and 2005-2011 were treated as "before" and "after" periods to evaluate the intervention's impact on the mean caesarean section rate, a significant reduction was noted: from 54.8% to 40.3% (odds ratio, OR: 0.56; 95% confidence interval, Cl: 0.52-0.59;X-2 test: P < 0.001). The overall drop in the caesarean section rate was significant (X-2 test: P < 0.001) and inversely correlated with the years (Spearman's p: -0.096; P < 0.001). Although complicated pregnancies increased after 2004, the primary caesarean section rate decreased annually by 20% on average in 2005-2011, after practice audits were implemented. Multiple logistic regression showed a positive association between the caesarean delivery rate and the rate of admission to the NICU (adjusted OR: 1.26; 95% CI: 1.14-1.40).Conclusion Patient and staff education and practice audits reduced the Caesarean section rate in a tertiary referral hospital without an increase in admissions to the NICU.