University of California, San Francisco, School of Nursing, San Francisco, California.
Washington State University, Department of Health Policy and Administration, Spokane, Washington.
Womens Health Issues. 2017 Jul-Aug;27(4):434-440. doi: 10.1016/j.whi.2017.01.002. Epub 2017 Feb 16.
Obstetrical care often involves multiple expensive, and often elective, interventions that may increase costs to patients, payers, and the health care system with little effect on patient outcomes. The objectives of this study were to examine the following hospital related outcomes: 1) use of labor and birth interventions, 2) inpatient duration of stay, and 3) total direct health care costs for patients attended by a certified nurse-midwife (CNM) compared with those attended by an obstetrician-gynecologist (OB-GYN), within an environment of safe and high-quality care.
Electronic health records for 1,441 medically low-risk women who gave birth at a hospital located in the U.S. Pacific Northwest between January and September 2013 were sampled. Multilevel regression and generalized linear models were used for analysis.
Reduced use of selected labor and birth interventions (cesarean delivery, vacuum-assisted delivery, epidural anesthesia, labor induction, and cervical ripening), reduced maternal duration of stay, and reduced overall costs associated with CNM-led care relative to OB-GYN-led care were observed for medically low-risk women in a hospital setting. Maternal and neonatal outcomes were comparable across groups.
This study supports consideration of increased use of CNMs as providers for the care of women at low risk for complications to decrease costs for the health care system. The use of CNMs to the fullest extent within state-regulated scopes of practice could result in more efficient use of hospital resources.
产科护理通常涉及多种昂贵的、通常是选择性的干预措施，这些干预措施可能会增加患者、支付方和医疗保健系统的成本，但对患者的结局几乎没有影响。本研究的目的是检查以下与医院相关的结果：1）分娩干预措施的使用情况，2）住院时间，以及 3）在安全且高质量的护理环境下，由认证的注册护士助产士（CNM）护理的患者与由妇产科医生（OB-GYN）护理的患者相比，其直接医疗保健总成本。
抽取了 2013 年 1 月至 9 月期间在美国太平洋西北地区一家医院分娩的 1441 名低危产妇的电子健康记录。采用多水平回归和广义线性模型进行分析。
在医院环境下，与 OB-GYN 护理相比，低危产妇中使用的选择性分娩干预措施（剖宫产、真空辅助分娩、硬膜外麻醉、引产和宫颈成熟）减少，产妇住院时间缩短，与 CNM 护理相关的总体成本降低。母婴结局在各组之间相当。
本研究支持考虑增加 CNM 作为低并发症风险女性护理提供者，以降低医疗保健系统的成本。在州监管的实践范围内充分利用 CNM 可以更有效地利用医院资源。
