墨西哥PRONTO项目的影响评估：一项基于模拟的产科和新生儿紧急情况及团队培训项目。
Impact Evaluation of PRONTO Mexico: A Simulation-Based Program in Obstetric and Neonatal Emergencies and Team Training.
作者信息
Walker Dilys M, Cohen Susanna R, Fritz Jimena, Olvera-García Marisela, Zelek Sarah T, Fahey Jenifer O, Romero-Martínez Martín, Montoya-Rodríguez Alejandra, Lamadrid-Figueroa Héctor
机构信息
From the Department of Obstetrics and Gynecology and Global Health (D.M.W.), University of Washington, Seattle, WA; College of Nursing (S.R.C.), University of Utah, Salt Lake City, UT; Division of Reproductive Health (J.F., M.O., A.M., H.L.-F.), Research Center for Population Health, National Institute of Public Health, Cuernavaca, Mexico; Department of Global Health (S.T.Z.), University of Washington, Seattle, WA; Department of Obstetrics and Gynecology (J.O.F.), University of Maryland School of Medicine, Baltimore, MD; and Center for Evaluation Research and Surveys (M.R.-M.), National Institute of Public Health, Cuernavaca, Mexico.
出版信息
Simul Healthc. 2016 Feb;11(1):1-9. doi: 10.1097/SIH.0000000000000106.
INTRODUCTION
Most maternal deaths in Mexico occur within health facilities, often attributable to suboptimal care and lack of access to emergency services. Improving obstetric and neonatal emergency care can improve health outcomes. We evaluated the impact of PRONTO, a simulation-based low-cost obstetric and neonatal emergency and team training program on patient outcomes.
METHODS
We conducted a pair-matched hospital-based trial in Mexico from 2010 to 2013 with 24 public hospitals. Obstetric and neonatal care providers participated in PRONTO trainings at intervention hospitals. Control hospitals received no intervention. Outcome measures included hospital-based neonatal mortality, maternal complications, and cesarean delivery. We fitted mixed-effects negative binomial regression models to estimate incidence rate ratios and 95% confidence intervals using a difference-in-differences approach, cumulatively, and at follow-up intervals measured at 4, 8, and 12 months.
RESULTS
There was a significant estimated impact of PRONTO on the incidence of cesarean sections in intervention hospitals relative to controls adjusting for baseline differences during all 12 months cumulative of follow-up (21% decrease, P = 0.005) and in intervals measured at 4 (16% decrease, P = 0.02), 8 (20% decrease, P = 0.004), and 12 months' (20% decrease, P = 0.003) follow-up. We found no statistically significant impact of the intervention on the incidence of maternal complications. A significant impact of a 40% reduction in neonatal mortality adjusting for baseline differences was apparent at 8 months postintervention but not at 4 or 12 months.
CONCLUSIONS
PRONTO reduced the incidence of cesarean delivery and may improve neonatal mortality, although the effect on the latter might not be sustainable. Further study is warranted to confirm whether obstetric and neonatal emergency simulation and team training can have lasting results on patient outcomes.
引言
墨西哥大多数孕产妇死亡发生在医疗机构内，这通常归因于护理水平欠佳以及无法获得紧急服务。改善产科和新生儿急救护理可改善健康结局。我们评估了PRONTO（一项基于模拟的低成本产科和新生儿急救及团队培训项目）对患者结局的影响。
方法
2010年至2013年，我们在墨西哥的24家公立医院开展了一项配对匹配的医院试验。产科和新生儿护理人员在干预医院参加了PRONTO培训。对照医院未接受干预。结局指标包括基于医院的新生儿死亡率、孕产妇并发症和剖宫产率。我们采用差异中的差异方法，累计并在4、8和12个月的随访间隔期，拟合混合效应负二项回归模型来估计发病率比和95%置信区间。
结果
在对12个月累计随访期间的基线差异进行调整后，相对于对照医院，PRONTO对干预医院剖宫产率的影响具有统计学意义（降低21%，P = 0.005），在4个月（降低16%，P = 0.02）、8个月（降低20%，P = 0.004）和12个月（降低20%，P = 0.003）的随访间隔期也具有统计学意义。我们发现该干预对孕产妇并发症发生率没有统计学意义上的显著影响。在干预后8个月，对新生儿死亡率进行基线差异调整后降低40%的显著影响很明显，但在4个月或12个月时不明显。
结论
PRONTO降低了剖宫产率，并且可能改善新生儿死亡率，尽管对后者的影响可能无法持续。有必要进一步研究以确认产科和新生儿急救模拟及团队培训是否能对患者结局产生持久影响。
Zotero 插件