Laditka Sarah B, Laditka James N, Mastanduno Melanie P, Lauria Michele R, Foster Tina C
Master of Health Administration Program, Department of Health Services Policy and Management, Arnold School of Public Health, Health Sciences Bldg, 116F, 800 Sumter Street, Columbia, SC 29208, USA.
Women Health. 2005;41(3):1-26. doi: 10.1300/J013v41n03_01.
We identified Potentially Avoidable Maternity Complications (PAMCs). Used with hospital discharge data, PAMCs may indicate lack of prenatal care access.
A research team of two obstetrician/gynecologists and three health services researchers developed the PAMC indicator, which was verified by external review. AIM 1 used the National Maternal and Infant Health Survey, with prenatal care information and 8,661 pregnancy hospitalizations, to examine associations between prenatal care, risk factors, and PAMCs. AIM 2 used the 1997 Nationwide Inpatient Sample (NIS), with 895,259 pregnancy-related hospitalizations, to examine PAMC risks for groups likely to have prenatal care access problems.
In AIM 1, adequate prenatal care reduced PAMC risks by 57% (p < .01). Compared to nonsmokers, the odds of a PAMC for smokers were 86% higher (p < .01). Cocaine use increased PAMC risk notably (odds ratio 3.35, p < .0001). In the multivariate analyses of AIM 2, African Americans, the uninsured, and Medicaid beneficiaries had high PAMC risks (all p < .0001).
Findings suggest adequate prenatal care may reduce PAMC risks. Results for groups with less prenatal care access were consistent with previous research using less refined indicators, such as low birth weight. PAMCs improve on earlier measures, and readily permit adjustments for mothers' ages and comorbidities.
我们确定了潜在可避免的产科并发症（PAMCs）。将其与医院出院数据结合使用时，PAMCs可能表明缺乏产前护理服务。
由两名妇产科医生和三名卫生服务研究人员组成的研究团队制定了PAMC指标，并通过外部评审进行了验证。目标1使用了全国母婴健康调查，该调查包含产前护理信息和8661例妊娠住院病例，以研究产前护理、风险因素与PAMCs之间的关联。目标2使用了1997年全国住院样本（NIS），其中有895259例与妊娠相关的住院病例，以研究可能存在产前护理服务获取问题的群体的PAMC风险。
在目标1中，充分的产前护理使PAMC风险降低了57%（p <.01）。与不吸烟者相比，吸烟者发生PAMC的几率高86%（p <.01）。使用可卡因显著增加了PAMC风险（比值比3.35，p <.0001）。在目标2的多变量分析中，非裔美国人、未参保者和医疗补助受益人有较高的PAMC风险（均p <.0001）。
研究结果表明充分的产前护理可能降低PAMC风险。产前护理服务获取较少的群体的结果与先前使用不太精确指标（如低出生体重）的研究一致。PAMCs比早期的测量方法有所改进，并且很容易对母亲的年龄和合并症进行调整。
