Regionalised maternity care - is there room for improvement?

在提供产妇护理方面的一个核心难题是，有些母亲和婴儿需要获得专门知识和先进技术，但大多数母亲和婴儿不需要。在澳大利亚，区域化孕产妇护理旨在确保向所有妇女提供适当水平的护理，方法是在产前确定有风险的妊娠，随后在需要时转移到风险适当的环境。此外，推迟生育和剖腹产率的增加正在增加现有医疗条件和不良妊娠结果风险因素的妇女人数。迫切需要根据妇女的产前状况和怀孕早期或怀孕期间可查明的风险因素，确定风险适当的产妇护理水平。该项目将利用现有的人口健康数据集，以确定区域化的孕产妇保健在多大程度上使妇女及其婴儿在风险适当的环境中分娩，或者是否有改进的余地，将更多的高危妊娠转移到更高级别的保健。母婴结局的差异可能是由于怀孕前或怀孕期间发生的因素，也可能是由于提供的产妇护理水平的差异。我们需要考虑产妇因素，以公平评估产妇保健水平的作用。为了做到这一点，我们的项目将开发和利用创新的统计技术来研究与母亲及其婴儿的不良结局（严重疾病或死亡）相关的风险因素。然后，我们将能够“预测”结果，看看产妇护理水平之间的差异是否是真实的。如果这些差异是由于护理水平不同造成的，那么，在改进孕产服务方面还有巨大的潜力。研究结果可用于指导卫生服务政策和组织变革，以改善孕产妇保健和优化妊娠结局，使生命有一个健康的开端。

A central dilemma in the provision of maternity care is that some mothers and babies need access to expertise and sophisticated technologies, but most do not. In Australia regionalised maternity care aims to ensure the provision of the appropriate level of care to all women, via antenatal identification of at-risk pregnancies and subsequent transfer to risk-appropriate settings, should the need arise. Furthermore, delayed childbearing and increasing rates of caesarean section are increasing the pool of women with existing medical conditions and risk factors for adverse pregnancy outcomes. There is an urgent need to identify risk-appropriate levels of maternity care based on women's antenatal conditions and risk factors that can be identified early or during pregnancy. The project will use existing population health data sets to determine to what extent regionalised maternity care is delivering women and their babies in risk-appropriate settings or whether there is room for improvement through increased transfer of at-risk pregnancies to higher levels of care. Variations in outcomes for mothers and babies may be due to factors that occur before or during pregnancy, or may be due to differences in the level of maternity care provided. We need to take account of maternal factors to fairly assess the role of the level of maternity care. To do this our project will develop and utilise innovative statistical techniques to look at the risk factors associated with poor outcomes (severe illness or death) for mothers and their babies. We will then be able to 'predict' outcomes and see if differences between levels of maternity care are real or not. If variations are explained by different levels of care then there is enormous potential for improvement in the provision of maternity services. Results could be applied to direct health services policy and organisational changes to improve maternity care and optimise pregnancy outcomes for a healthy start to life.