Turnbull Deborah A, Wilkinson Chris, Gerard Karen, Shanahan Marian, Ryan Philip, Griffith Elizabeth C, Kruzins Gillian, Stamp Georgina E
Department of General Practice, Women's and Children's Hospital, Adelaide, Australia.
Lancet. 2004 Apr 3;363(9415):1104-9. doi: 10.1016/S0140-6736(04)15893-5.
Day care is increasingly being used for complications of pregnancy, but there is little published evidence on its efficacy. We assessed the clinical, psychosocial, and economic effects of day care for three pregnancy complications in a randomised trial of day care versus standard care on an antenatal ward.
395 women were randomly assigned day (263) or ward (132) care in a ratio of two to one, stratified for major diagnostic categories (non-proteinuric hypertension, proteinuric hypertension, and preterm premature rupture of membranes). The research hypothesis was that for these disorders, as an alternative to admission, antenatal day care will reduce specified interventions and investigations, result in no differences in clinical outcome, lead to greater satisfaction and psychological wellbeing, and be more cost-effective. Data were collected through case-note review, self-report questionnaires (response rates 81.0% or higher) and via the hospital's financial system. Analysis was by intention to treat.
All participants were included in the analyses. There were no differences between the groups in antenatal tests or investigations or intrapartum interventions. The total duration of antenatal care episodes was shorter in the day-care group than in the ward group (median 17 [IQR 5-9] vs 57 [35-123] h; p=0.001). Overall stay was also significantly shorter in the day-care group (mean 7.22 [SE 0.31] vs 8.53 [0.44]; p=0.014). The median number of care episodes was three (range one to 14) in the day-care group and two (one to nine) in the ward group (p=0.01). There were no statistically or clinically significant differences in maternal or perinatal outcomes. The day-care group reported greater satisfaction, with no evidence of unintended psychosocial sequelae. There was no significant difference in either average cost per patient or average cost per day of care.
Since clinical outcomes and costs are similar, adoption by maternity services of a policy providing specified women with the choice between admission and day-unit care seems appropriate.
日间护理越来越多地用于妊娠并发症，但关于其疗效的公开证据很少。我们在一项日间护理与产前病房标准护理的随机试验中，评估了日间护理对三种妊娠并发症的临床、心理社会和经济影响。
395名妇女按二比一的比例随机分配接受日间（263名）或病房（132名）护理，按主要诊断类别（非蛋白尿性高血压、蛋白尿性高血压和胎膜早破）分层。研究假设是，对于这些疾病，作为入院的替代方案，产前日间护理将减少特定的干预措施和检查，临床结局无差异，带来更高的满意度和心理健康水平，并且更具成本效益。数据通过病例记录审查、自我报告问卷（回复率81.0%或更高）以及医院财务系统收集。分析采用意向性分析。
所有参与者均纳入分析。两组在产前检查或调查以及产时干预方面没有差异。日间护理组的产前护理总时长比病房组短（中位数17[四分位间距5 - 9]小时对57[35 - 123]小时；p = 0.001）。日间护理组的总体住院时间也显著更短（均值7.22[标准误0.31]对8.53[0.44]；p = 0.014）。日间护理组的护理次数中位数为3次（范围1至14次），病房组为2次（1至9次）（p = 0.01）。母婴或围产期结局在统计学或临床上均无显著差异。日间护理组报告的满意度更高，没有意外心理社会后遗症的证据。每位患者的平均费用或每天护理的平均费用均无显著差异。
由于临床结局和成本相似，产科服务采用一项为特定女性提供入院护理和日间护理选择的政策似乎是合适的。
