Two practice models in one labor and delivery unit: association with cesarean delivery rates.
Two practice models in one labor and delivery unit: association with cesarean delivery rates.
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DOI：
10.1016/j.ajog.2014.11.014
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发表时间：
2015-04
影响因子：
9.8
通讯作者：
Cheng Y
中科院分区：
文献类型：
--
作者：
Nijagal MA;Kuppermann M;Nakagawa S;Cheng Y
目的：探讨某社区医院分娩实践模式与剖宫产率的关系。这是一项回顾性队列研究，在一家社区医院对9,381例单胎活产进行了研究，在两种不同的实践模式下，妇女在其中一种模式下接受分娩和分娩护理：传统的“私人”实践模式和助产士-医生“laborist”实践模式。通过实践模型比较剖宫产率，调整潜在的社会人口统计学和临床混杂因素。采用卡方检验和多变量逻辑回归进行统计比较。与助产士/化验员模式下管理的妇女相比，私人模式下的妇女更有可能进行剖宫产（31.6% vs 17.3%, p<0.001；调整优势比[aOR] 2.11, 95%可信区间[CI] 1.73-2.58）。未产、足月、单胎、胎顶（NTSV）妊娠的妇女如果接受私人模式的护理，剖腹产的可能性也更大（29.8%对15.9%,p<0.001; aOR 1.86, 95% CI 1.33-2.58），之前有过剖宫产的妇女也是如此（71.3%对41.4%,p<0.001; aOR 3.19, 95% CI 1.74-5.88）。在这个社区医院环境中，助产士-医师-实验室医师执业模式比私人执业模式与较低的剖宫产率相关。
To examine the association between labor and delivery practice model and cesarean delivery rates at a community hospital. This was a retrospective cohort study of 9,381 singleton live births at one community hospital, where women were provided labor and delivery care under one of two distinct practice models: a traditional “private” practice model and a midwife-physician “laborist” practice model. Cesarean rates were compared by practice model, adjusting for potential sociodemographic and clinical confounders. Statistical comparisons were performed using the chi square test and multivariable logistical regression. Compared with women managed under the midwife/laborist model, women in the private model were significantly more likely to have a cesarean delivery (31.6% vs 17.3%, p<0.001; adjusted odds ratio [aOR] 2.11, 95% confidence interval [CI] 1.73-2.58). Women with nulliparous, term, singleton, vertex (NTSV) gestations also were more likely to have a cesarean delivery if they were cared for in the private model (29.8% versus 15.9%, p<0.001; aOR 1.86, 95% CI 1.33-2.58) as were women who had a prior cesarean delivery (71.3% versus 41.4%, p<0.001; aOR 3.19, 95% CI 1.74-5.88). In this community hospital setting, a midwife-physician laborist practice model was associated with lower cesarean rates than a private practice model.