Korst Lisa M, Reyes Carolina, Fridman Moshe, Lu Michael C, Hobel Calvin J, Gregory Kimberly D
Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Obstet Gynecol. 2006 Mar;107(3):632-40. doi: 10.1097/01.AOG.0000201975.49956.eb.
Inpatient conditions that might be avoided through improved outpatient services are called Ambulatory Care Sensitive Indicators, and they include pyelonephritis in nonpregnant adults. No such indicators have been developed for pregnant women. We examine whether hospital-specific rates of gestational pyelonephritis may serve as a measure of the quality of ambulatory maternal care.
The California Department of Health Services provided an administrative data set linking maternal and newborn delivery records for 1997 with antepartum hospital admissions. We created a "low-risk" study population by largely excluding women with maternal, fetal, and placental morbidities and those with no first-trimester prenatal care. We generated hospital-specific infection rates using a Bayesian hierarchical logistic regression model.
We identified 280,816 low-risk women, of whom 1,853 (0.66%) had at least 1 inpatient admission for gestational pyelonephritis. The model suggested only 2 risk factors: MediCal as a payer (odds ratio 1.60, 95% confidence interval 1.46-1.80 compared with all other payers), and African-American race (odds ratio 1.24, 95% confidence interval 1.10-1.41 compared with white race). Women with pyelonephritis were more than twice as likely to deliver preterm. Adjusted rates of gestational pyelonephritis for the 291 hospitals in the sample ranged from 0.22% to 2.64%.
These findings suggest that because of its preventability, its consequent related morbidity, and the variation in hospital-specific rates, gestational pyelonephritis meets both clinical and technical requirements as a quality indicator for ambulatory maternal care. The use of such rates would provide an opportunity for hospitals to improve patient outcomes through partnership with obstetricians in the management of women at risk.
II-3.
可通过改善门诊服务避免的住院情况被称为门诊护理敏感指标，其中包括非妊娠成年女性的肾盂肾炎。目前尚未针对孕妇制定此类指标。我们研究妊娠肾盂肾炎的医院特定发生率是否可作为门诊孕产妇护理质量的一项衡量指标。
加利福尼亚州卫生服务部提供了一个行政数据集，将1997年的孕产妇和新生儿分娩记录与产前住院情况相联系。我们通过大量排除患有孕产妇、胎儿和胎盘疾病的女性以及那些未接受孕早期产前护理的女性，创建了一个“低风险”研究人群。我们使用贝叶斯分层逻辑回归模型生成医院特定感染率。
我们识别出280,816名低风险女性，其中1,853名（0.66%）因妊娠肾盂肾炎至少有1次住院治疗。该模型仅显示出2个风险因素：作为支付方的医疗救助计划（与所有其他支付方相比，优势比为1.60，95%置信区间为1.46 - 1.80），以及非裔美国人种族（与白人种族相比，优势比为1.24，95%置信区间为1.10 - 1.41）。患有肾盂肾炎的女性早产的可能性是其两倍多。样本中291家医院的妊娠肾盂肾炎校正发生率在0.22%至2.64%之间。
这些发现表明，由于妊娠肾盂肾炎具有可预防性、随之而来的相关发病率以及医院特定发生率的差异，它满足作为门诊孕产妇护理质量指标的临床和技术要求。使用此类发生率将为医院提供一个机会，通过与产科医生合作管理高危女性来改善患者结局。
II - 3。
