Tracy Sally K, Welsh Alec, Hall Bev, Hartz Donna, Lainchbury Anne, Bisits Andrew, White Jan, Tracy Mark B
Midwifery and Women's Health Research Unit, Royal Hospital for Women, Barker Street, Randwick, New South Wales 2031, Australia.
BMC Pregnancy Childbirth. 2014 Jan 24;14:46. doi: 10.1186/1471-2393-14-46.
In many countries midwives act as the main providers of care for women throughout pregnancy, labour and birth. In our large public teaching hospital in Australia we restructured the way midwifery care is offered and introduced caseload midwifery for one third of women booked at the hospital. We then compared the costs and birth outcomes associated with caseload midwifery compared to the two existing models of care, standard hospital care and private obstetric care.
We undertook a cross sectional study examining the risk profile, birth outcomes and cost of care for women booked into one of the three available models of care in a tertiary teaching hospital in Australia between July 1st 2009 December 31st 2010. To control for differences in population or case mix we described the outcomes for a cohort of low risk first time mothers known as the 'standard primipara'.
Amongst the 1,379 women defined as 'standard primipara' there were significant differences in birth outcome. These first time 'low risk' mothers who received caseload care were more likely to have a spontaneous onset of labour and an unassisted vaginal birth 58.5% in MGP compared to 48.2% for Standard hospital care and 30.8% with Private obstetric care (p < 0.001). They were also significantly less likely to have an elective caesarean section 1.6% with MGP versus 5.3% with Standard care and 17.2% with private obstetric care (p < 0.001). From the public hospital perspective, over one financial year the average cost of care for the standard primipara in MGP was $3903.78 per woman. This was $1375.45 less per woman than those receiving Private obstetric care and $1590.91 less than Standard hospital care per woman (p < 0.001). Similar differences in cost were found in favour of MGP for all women in the study who received caseload care.
Cost reduction appears to be achieved through reorganising the way care is delivered in the public hospital system with the introduction of Midwifery Group Practice or caseload care. The study also highlights the unexplained clinical variation that exists between the three models of care in Australia.
在许多国家，助产士是孕期、分娩期及产褥期妇女护理的主要提供者。在澳大利亚一家大型公立教学医院，我们对助产护理的提供方式进行了重组，并为三分之一在本院登记的孕妇引入了连续性护理助产模式。然后，我们将连续性护理助产模式与另外两种现有的护理模式（标准医院护理和私立产科护理）的护理成本及分娩结局进行了比较。
我们进行了一项横断面研究，调查了2009年7月1日至2010年12月31日期间在澳大利亚一家三级教学医院登记接受三种可用护理模式之一的妇女的风险状况、分娩结局及护理成本。为了控制人群或病例组合的差异，我们描述了一组低风险初产妇（即“标准初产妇”）的结局。
在1379名被定义为“标准初产妇”的妇女中，分娩结局存在显著差异。这些首次怀孕的“低风险”母亲接受连续性护理助产模式时，更有可能自然发动分娩并顺产，在连续性护理助产模式下为58.5%，而标准医院护理模式下为48.2%，私立产科护理模式下为30.8%（p<0.001）。她们进行择期剖宫产的可能性也显著降低，连续性护理助产模式下为1.6%，标准护理模式下为5.3%，私立产科护理模式下为17.2%（p<0.001）。从公立医院的角度来看，在一个财政年度内，连续性护理助产模式下标准初产妇的平均护理成本为每名妇女3903.78美元。这比接受私立产科护理的妇女每人少1375.45美元，比标准医院护理的妇女每人少1590.91美元（p<0.001）。在该研究中，接受连续性护理助产模式的所有妇女在成本方面也存在类似的有利于连续性护理助产模式的差异。
通过在公立医院系统引入助产士小组执业模式或连续性护理助产模式来重新组织护理提供方式，似乎实现了成本降低。该研究还突出了澳大利亚三种护理模式之间存在的无法解释的临床差异。
