O'Leary Peter, Breheny Nikki, Reid Gabrielle, Charles Taryn, Emery Jon
Office of Population Health Genomics, WA Health, Western Australia, Australia.
Aust N Z J Obstet Gynaecol. 2006 Oct;46(5):427-32. doi: 10.1111/j.1479-828X.2006.00629.x.
A relatively few centres across Australia provide screening tests for maternal serum markers or ultrasound measurement of fetal nuchal translucency to assess risk of fetal anomalies such as Down syndrome. While providers engage in external accreditation and quality assurance programs, state and federal governments have been slow to formulate relevant policies and standards.
In this paper we review the current practices across Australian states and territories and propose recommendations for developing a national policy framework.
Data on the number and types of screening tests provided as well as state policies, where they are available, were obtained from government reports and supplemented by a mail survey to selected stakeholders in each state or territory.
At a jurisdictional level, our results highlight the need to integrate the collection and monitoring of antenatal population-screening programs to assess clinical effectiveness and program performance (detection and screen-positive rates, uptake of diagnostic tests as a result of screening). Women's expectations and satisfaction with the information they are provided should be evaluated and used to adjust education resources. At a local level, collaboration between providers of the separate tests, both public and private, would enable the ascertainment of outcomes of integrated screening programs. To complete the cycle, these data should inform decisions to improve antenatal screening programs at a national level.
A primary goal at a national level would be to develop a consensus on key performance indicators for programs that clarify best practice guidelines and establish optimal performance and accreditation standards.
澳大利亚只有相对较少的几个中心提供孕妇血清标志物筛查测试或胎儿颈部透明带超声测量，以评估诸如唐氏综合征等胎儿异常的风险。虽然医疗机构参与外部认证和质量保证计划，但州和联邦政府在制定相关政策和标准方面行动迟缓。
在本文中，我们回顾了澳大利亚各州和领地的现行做法，并提出了制定国家政策框架的建议。
从政府报告中获取了所提供筛查测试的数量和类型以及州政策（若有）的数据，并通过对每个州或领地选定利益相关者的邮件调查进行补充。
在辖区层面，我们的结果凸显了整合产前人群筛查计划的收集和监测工作以评估临床效果和计划绩效（检测率和筛查阳性率、因筛查而接受诊断测试的比例）的必要性。应该评估女性对所提供信息的期望和满意度，并将其用于调整教育资源。在地方层面，公立和私立单独测试的提供者之间的合作将有助于确定综合筛查计划的结果。为了形成完整的循环，这些数据应能为在国家层面改进产前筛查计划的决策提供依据。
国家层面的一个主要目标是就计划的关键绩效指标达成共识，这些指标应阐明最佳实践指南并确立最佳绩效和认证标准。
