Clinical Excellence Research Center, Stanford University, Stanford, CA; Department of Obstetrics and Gynecology, Kaiser Permanente Medical Center, Oakland, CA.
Clinical Excellence Research Center, Stanford University, Stanford, CA; Global Health Sciences, University of California, San Francisco, CA.
Am J Obstet Gynecol. 2017 Mar;216(3):250.e1-250.e14. doi: 10.1016/j.ajog.2016.12.033. Epub 2016 Dec 29.
Obstetrical care in the United States is unnecessarily costly. Birth is 1 of the most common reasons for healthcare use in the United States and 1 of the top expenditures for payers every year. However, compared with other Organization for Economic Cooperation and Development countries, the United States spends substantially more money per birth without better outcomes. Our team at the Clinical Excellence Research Center, a center that is focused on improving value in healthcare, spent a year studying ways in which obstetrical care in the United States can deliver better outcomes at a lower cost. After a thoughtful discovery process, we identified ways that obstetrical care could be delivered with higher value. In this article, we recommend 3 redesign steps that foster the delivery of higher-value maternity care: (1) to provide long-acting reversible contraception immediately after birth, (2) to tailor prenatal care according to women's unique medical and psychosocial needs by offering more efficient models such as fewer in-person visits or group care, and (3) to create hospital-affiliated integrated outpatient birth centers as the planned place of birth for low-risk women. For each step, we discuss the redesign concept, current barriers and implementation solutions, and our estimation of potential cost-savings to the United States at scale. We estimate that, if this model were adopted nationally, annual US healthcare spending on obstetrical care would decline by as much as 28%.
美国的产科护理费用过高。分娩是美国最常见的医疗保健使用原因之一，也是每年支付方的最大支出之一。然而，与其他经济合作与发展组织国家相比，美国在每一次分娩上的花费要高得多，但却没有取得更好的结果。我们在临床卓越研究中心的团队专注于提高医疗保健的价值，该团队花了一年时间研究美国的产科护理如何以更低的成本实现更好的结果。经过深思熟虑的发现过程，我们确定了可以提供更高价值的产科护理方式。在本文中，我们建议采取 3 个重新设计步骤，以促进提供更高价值的产妇护理：（1）在分娩后立即提供长效可逆避孕措施；（2）根据女性独特的医疗和心理社会需求定制产前护理，提供更有效的模式，如减少面对面就诊次数或提供小组护理；（3）创建医院附属的综合门诊分娩中心，作为低风险女性的计划分娩地点。对于每个步骤，我们讨论了重新设计的概念、当前的障碍和实施解决方案，以及我们对美国大规模实施该模式的潜在节省成本的估计。我们估计，如果这种模式在全国范围内得到采用，美国产科护理的年度医疗保健支出将减少 28%之多。
