High Risk Pregnancy Center, Las Vegas, NV, USA.
Am J Obstet Gynecol. 2013 Sep;209(3):251.e1-6. doi: 10.1016/j.ajog.2013.06.040. Epub 2013 Jul 29.
Laborist programs have expanded throughout the United States in the last decade. Meanwhile, there has been no published research examining their effect on patient outcomes. Cesarean delivery is a key performance metric with maternal health implications and significant financial impact. Our hypothesis is that the initiation of a full-time dedicated laborist staff decreases cesarean delivery.
In a tertiary hospital staffed with private practice physicians, data were retrospectively reviewed for 3 time periods from 2006 through 2011. The first period (16 months) there were no laborists (traditional model), followed by 14 months of continuous in-hospital laborist coverage provided by community staff (community laborist), and finally a 24-month period with full-time laborists providing continuous in-hospital coverage. The primary hypothesis was that full-time laborists would decrease cesarean delivery rates.
Data from 6206 term nulliparous patients were retrospectively reviewed. The cesarean delivery rate for no laborist care was 39.2%, for community physician laborist care was 38.7%, and for full-time laborists was 33.2%. With adjustment via logistic regression, full-time laborist presence was associated with a significant reduction in cesarean delivery when contrasted with no laborist (odds ratio, 0.73; 95% confidence interval, 0.64-0.83; P < .0001) or community laborist care (odds ratio, 0.77; 95% confidence interval, 0.67-0.87; P < .001). The community laborist model was not associated with an effect upon cesarean delivery.
A dedicated full-time laborist staff model is associated with lower rates of cesarean delivery. These findings may be used as part of a strategy to reduce cesarean delivery, lower maternal morbidity and mortality, and decrease health care costs.
在过去十年中，劳工计划已在美国各地扩展。与此同时，尚无关于研究其对患者结局影响的已发表研究。剖宫产是具有母婴健康意义和重大财务影响的关键绩效指标。我们的假设是，全职专职劳工的启动会降低剖宫产率。
在一家由私人执业医师提供服务的三级医院中，回顾性地审查了 2006 年至 2011 年的三个时间段的数据。第一个时间段（16 个月）没有劳工（传统模式），接下来是 14 个月的社区工作人员提供的连续院内劳工覆盖（社区劳工），最后是 24 个月的全职劳工提供连续院内覆盖。主要假设是全职劳工会降低剖宫产率。
回顾性地审查了 6206 名足月初产妇的数据。无劳工护理的剖宫产率为 39.2％，社区医生劳工护理为 38.7％，全职劳工为 33.2％。通过逻辑回归进行调整后，与无劳工（优势比，0.73；95％置信区间，0.64-0.83；P <0.0001）或社区劳工护理（优势比，0.77；95％置信区间，0.67-0.87；P <0.001）相比，全职劳工的存在与剖宫产率显著降低相关。社区劳工模型与剖宫产率无关联。
专职全职劳工人员模式与剖宫产率降低相关。这些发现可用于降低剖宫产率，降低母婴发病率和死亡率以及降低医疗保健成本的策略的一部分。
