产科护理中的系统因素：每日产科工作量的作用。

Systems factors in obstetric care: the role of daily obstetric volume.

机构信息

Departments of Obstetrics and Gynecology, Medical Informatics and Clinical Epidemiology, and Emergency Medicine, and the Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, Oregon; and the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California.

出版信息

Obstet Gynecol. 2013 Oct;122(4):851-857. doi: 10.1097/AOG.0b013e3182a2dd93.

DOI:10.1097/AOG.0b013e3182a2dd93

PMID:24084544

Abstract

OBJECTIVE

To evaluate whether relatively high-volume days are associated with measures of obstetric care in California hospitals.

METHODS

This is a population-based retrospective cohort study of linked data from birth certificates and antepartum and postpartum hospital discharge records for California births in 2006. Birth asphyxia and nulliparous, term, singleton, vertex cesarean delivery rates were analyzed as markers of quality of obstetric care. Rates were compared between hospital-specific relatively high-volume days (days when the number of births exceeded the 75th percentile of daily volume for that hospital) and low-volume or average-volume days. Analyses were stratified by weekend and weekday and overall hospital obstetric volume. Multivariable logistic regression was used to control for confounders.

RESULTS

On weekends, relatively high-volume days were significantly associated with an elevated risk of asphyxia (27 out of 10,000 compared with 17 out of 10,000; P=.013), whereas no association was present on weekdays (13 out of 10,000 on high-volume days and 15 out of 10,000 on low-volume or average-volume days; P=.182). The cesarean delivery rate among the nulliparous, term, singleton, vertex population was significantly lower on high-volume weekend days (22.0% compared with 23.6% on low-volume or average-volume weekend days; P=.009), whereas no association was present on weekdays (27.1% on high-volume days and 27.6% on low-volume or average-volume days; P=.092).

CONCLUSION

Delivery on relatively high-volume weekend days is a risk factor for birth asphyxia in California. High-volume weekend days also are associated with a lower rate of cesarean delivery in nulliparous women with singleton, vertex presentation pregnancies at term.

LEVEL OF EVIDENCE

: II.

摘要

目的

评估加利福尼亚州医院中相对高容量日是否与产科护理措施相关。

方法

这是一项基于人群的回顾性队列研究，对 2006 年加利福尼亚州出生的分娩证明以及产前和产后住院记录进行了数据链接。将出生窒息和初产妇、足月、单胎、头位剖宫产率作为产科护理质量的标志物进行分析。在周末和工作日以及整个医院产科容量方面，比较了医院特定的相对高容量日（出生人数超过该医院日容量第 75 百分位数的日子）和低容量或平均容量日的比率。分析按周末和工作日以及整体医院产科容量进行分层。采用多变量逻辑回归控制混杂因素。

结果

在周末，相对高容量日与窒息风险升高显著相关（每 10000 例中有 27 例，而每 10000 例中有 17 例；P=.013），而在工作日则没有关联（每 10000 例中有 13 例发生在高容量日，每 10000 例中有 15 例发生在低容量或平均容量日；P=.182）。初产妇、足月、单胎、头位人群中，高容量周末日剖宫产率显著降低（22.0%，而低容量或平均容量周末日为 23.6%；P=.009），而在工作日则没有关联（高容量日为 27.1%，低容量或平均容量日为 27.6%；P=.092）。