Gao Yu, Gold Lisa, Josif Cath, Bar-Zeev Sarah, Steenkamp Malinda, Barclay Lesley, Zhao Yuejen, Tracy Sally, Kildea Sue
University Centre for Rural Health North Coast, School of Public Health, Sydney Medical School, University of Sydney, Lismore, NSW 2480, Australia.
Deakin Population Health SRC, Faculty of Health, Deakin University, Burwood, VIC 3125, Australia.
Midwifery. 2014 Apr;30(4):447-55. doi: 10.1016/j.midw.2013.04.004. Epub 2013 Jun 18.
to compare the cost-effectiveness of two models of service delivery: Midwifery Group Practice (MGP) and baseline cohort.
a retrospective and prospective cohort study.
a regional hospital in Northern Territory (NT), Australia.
baseline cohort included all Aboriginal mothers (n=412), and their infants (n=416), from two remote communities who gave birth between 2004 and 2006. The MGP cohort included all Aboriginal mothers (n=310), and their infants (n=315), from seven communities who gave birth between 2009 and 2011. The baseline cohort mothers and infant's medical records were retrospectively audited and the MGP cohort data were prospectively collected. All the direct costs, from the Department of Health (DH) perspective, occurred from the first antenatal presentation to six weeks post partum for mothers and up to 28 days post births for infants were included for analysis.
analysis was performed with SPSS 19.0 and Stata 12.1. Independent sample of t-tests and χ2 were conducted.
women receiving MGP care had significantly more antenatal care, more ultrasounds, were more likely to be admitted to hospital antenatally, and had more postnatal care in town. The MGP cohort had significantly reduced average length of stay for infants admitted to Special Care Nursery (SCN). There was no significant difference between the two cohorts for major birth outcomes such as mode of birth, preterm birth rate and low birth weight. Costs savings (mean A$703) were found, although these were not statistically significant, for women and their infants receiving MGP care compared to the baseline cohort.
for remote dwelling Aboriginal women of all risk who travelled to town for birth, MGP was likely to be cost effective, and women received better care and resulting in equivalent birth outcomes compared with the baseline maternity care.
比较两种服务模式的成本效益：助产士团体执业模式（MGP）和基线队列模式。
一项回顾性和前瞻性队列研究。
澳大利亚北领地（NT）的一家地区医院。
基线队列包括2004年至2006年间在两个偏远社区分娩的所有原住民母亲（n = 412）及其婴儿（n = 416）。MGP队列包括2009年至2011年间在七个社区分娩的所有原住民母亲（n = 310）及其婴儿（n = 315）。对基线队列母亲及其婴儿的病历进行回顾性审核，并前瞻性收集MGP队列数据。从卫生部（DH）的角度来看，所有直接成本包括从首次产前检查到产后六周的母亲费用以及婴儿出生后最多28天的费用，纳入分析。
使用SPSS 19.0和Stata 12.1进行分析。进行独立样本t检验和χ2检验。
接受MGP护理的女性产前护理显著更多，超声检查更多，产前更有可能入院，并且在城镇接受的产后护理更多。MGP队列中入住特殊护理病房（SCN）的婴儿平均住院时间显著缩短。在主要分娩结局如分娩方式、早产率和低出生体重方面，两个队列之间没有显著差异。与基线队列相比，接受MGP护理的女性及其婴儿发现有成本节约（平均703澳元），尽管这些在统计学上不显著。
对于所有有风险且前往城镇分娩的偏远居住原住民女性，MGP可能具有成本效益，并且与基线产妇护理相比，女性获得了更好的护理，分娩结局相当。
