Britt David W, Bronstein Janet, Norton Jonathan D
Fetal Medicine Foundation of America, 131 East 65th Street, New York, USA.
BMC Pregnancy Childbirth. 2006 Apr 4;6:11. doi: 10.1186/1471-2393-6-11.
Prior research has shown that resources have an impact on birth outcomes. In this paper we ask how combinations of telemedical and hospital-level resources impact transports of mothers expecting very low birth weight (VLBW) babies in Arkansas.
Using de-identified birth certificate data from the Arkansas Department of Health, data were gathered on transports of women carrying VLBW babies for two six-month periods: a period just before the start of ANGELS (12/02-05/03), a telemedical outreach program for high-risk pregnancies, and a period after the program had been running for six months (12/03-05/04). For each maternal transport, the following information was recorded: maternal race-ethnicity, maternal age, and the birth weight of the infant. Logistic regression was used to assess the relationship between the predictors (telemedicine, hospital level, maternal characteristics) and the probability of a transport.
Having a telemedical site available increases the probability of a mother carrying a VLBW baby being transported to a level III facility either before or during birth. Having at least a level II nursery also increases the chance of a maternal transport. Where both level II nurseries and telemedical access are available, the odds of VLBW maternal transports are only modestly increased in comparison to the case where neither is present. At the individual level, Hispanic mothers were less likely to be transported than other mothers, and teenaged mothers were more likely to be transported than those 18 and over. A mother's being Black or being over 35 did not have an impact on the odds of being transported to a level III facility.
Combinations of resources have an impact on physician decisions regarding VLBW transports and are interpretable in terms of the capacity to diagnose and absorb risk. We suggest a collegial review of transport patterns and birth outcomes from areas with different levels of resources as a vehicle for moving the entire system of care forward over time. With such an evidence-based review in place, the collegial relations among level III specialists and obstetricians from around the state can, over time, develop workable protocols for when and how level III facilities should be involved.
先前的研究表明，资源会对出生结局产生影响。在本文中，我们探讨远程医疗资源与医院层面资源的组合如何影响阿肯色州极低出生体重（VLBW）婴儿母亲的转运情况。
利用阿肯色州卫生部提供的经过身份识别处理的出生证明数据，收集了两个为期六个月期间携带VLBW婴儿的女性的转运数据：ANGELS（一项针对高危妊娠的远程医疗外展项目）启动前的时期（2002年12月 - 2003年5月），以及该项目运行六个月后的时期（2003年12月 - 2004年5月）。对于每一次产妇转运，记录了以下信息：产妇的种族 - 民族、产妇年龄和婴儿的出生体重。采用逻辑回归分析来评估预测因素（远程医疗、医院级别、产妇特征）与转运概率之间的关系。
有远程医疗站点会增加携带VLBW婴儿的母亲在产前或产时被转运到三级医疗机构的概率。至少拥有二级新生儿重症监护室也会增加产妇转运的几率。在同时具备二级新生儿重症监护室和远程医疗服务的情况下，与两者都没有的情况相比，VLBW产妇转运的几率仅适度增加。在个体层面，西班牙裔母亲被转运的可能性低于其他母亲，而青少年母亲被转运的可能性高于18岁及以上的母亲。母亲是黑人或年龄超过35岁对被转运到三级医疗机构的几率没有影响。
资源组合会影响医生关于VLBW产妇转运的决策，并且可以根据诊断和承担风险的能力来解释。我们建议对不同资源水平地区的转运模式和出生结局进行同行评审，以此作为推动整个医疗系统随着时间推移不断进步的一种手段。通过这样基于证据的评审，随着时间的推移，该州三级专家和产科医生之间的同行关系可以制定出可行的方案，明确三级医疗机构何时以及如何参与其中。
