比较产科麻醉活动指数与总分娩数作为以色列产科单位工作量需求的单一分母。

Comparison of the obstetric anesthesia activity index with total delivery numbers as a single denominator of workload demand in Israeli maternity units.

机构信息

Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.

Department of Anesthesiology, Shaare Zedek Medical Center, Jerusalem, Israel.

出版信息

Isr J Health Policy Res. 2012 Dec 14;1(1):48. doi: 10.1186/2045-4015-1-48.

DOI:10.1186/2045-4015-1-48

PMID:23241308

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3541973/

Abstract

BACKGROUND

Obstetric anesthesia workload demand in Israel has increased due to both an increase in the requests for labor analgesia and a marked increase in the cesarean delivery rate. We propose a new workload-driven performance indicator, the Obstetric Anesthesia Activity Index (OAAI), to serve as a single denominator of obstetric anesthesia activity to enable direct comparison of different hospitals despite dissimilar rates of epidural labor analgesia and cesarean delivery.

METHODS

We performed a secondary analysis of two recent national surveys by the Israel Association of Obstetric Anesthesia. In 2005 and 2007 questionnaires were sent to all Israeli hospitals requesting information on the total numbers of deliveries, epidurals, and cesareans annually, together with the anesthesia workforce allocated for the provision of obstetric anesthesia services. The OAAI was calculated based on the premise that epidurals and cesareans are the predominant determinants of obstetric anesthesia workload and that a typical epidural takes about half the time of a typical cesarean. Accordingly, the OAAI for each hospital was calculated as ((0.75 * number of epidurals per year) + (1.5 * number of cesareans per year))/365.

RESULTS

This secondary analysis assessed the 25 maternity units in Israel that participated in both the 2005 and 2007 surveys. As expected, there was a wide inter-hospital variability in epidural and cesarean rates. Hospital rankings based on annual delivery numbers were different from those based on the OAAI. The OAAI correlated closely both with the number of epidurals (2005: Pearson 0.97, p < 0.0001; 2007: Pearson 0.97, p < 0.0001) and cesareans (2005: Pearson 0.94, p < 0.0001; 2007: Pearson 0.92, p < 0.0001). These correlations were better for the OAAI than for the annual delivery numbers.

CONCLUSIONS

As there was such a wide range of demand for different obstetric anesthesia services among different hospitals, the total number of deliveries is a poor summary indicator of obstetric anesthesia workload. The calculated OAAI better reflected the obstetric anesthesia workload as a single denominator of activity.

摘要

背景

由于分娩镇痛需求增加和剖宫产率显著上升，以色列产科麻醉工作量需求增加。我们提出了一种新的工作量驱动的绩效指标，产科麻醉活动指数（OAAI），作为产科麻醉活动的单一分母，以实现不同医院之间的直接比较，尽管硬膜外分娩镇痛和剖宫产率不同。

方法

我们对以色列产科麻醉协会最近进行的两项全国性调查进行了二次分析。2005 年和 2007 年，向所有以色列医院发送了问卷，要求提供每年的总分娩量、硬膜外分娩量和剖宫产量，以及用于提供产科麻醉服务的麻醉人员数量。OAAI 的计算前提是硬膜外分娩和剖宫产是产科麻醉工作量的主要决定因素，并且典型的硬膜外分娩时间大约是典型剖宫产的一半。因此，每个医院的 OAAI 计算为（每年硬膜外分娩量0.75+每年剖宫产量1.5）/365。

结果

这项二次分析评估了 2005 年和 2007 年参与两次调查的 25 家产科病房。如预期的那样，医院之间硬膜外分娩率和剖宫产率存在广泛的差异。基于每年分娩量的医院排名与基于 OAAI 的排名不同。OAAI 与硬膜外分娩量（2005 年：Pearson 0.97，p<0.0001；2007 年：Pearson 0.97，p<0.0001）和剖宫产量（2005 年：Pearson 0.94，p<0.0001；2007 年：Pearson 0.92，p<0.0001）密切相关。这些相关性比每年分娩量的相关性更好。