Boesveld Inge C, Bruijnzeels Marc A, Hitzert Marit, Hermus Marieke A A, van der Pal-de Bruin Karin M, van den Akker-van Marle M E, Steegers Eric A P, Franx Arie, de Vries Raymond G, Wiegers Therese A
Jan van Es Institute, Netherlands Expert Centre Integrated Primary Care, Wisselweg 33, 1314 CB, Almere, the Netherlands.
Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, PO Box 2014, 3000 CA, Rotterdam, the Netherlands.
BMC Health Serv Res. 2017 Jun 21;17(1):426. doi: 10.1186/s12913-017-2350-9.
The goal of integrated care is to offer a continuum of care that crosses the boundaries of public health, primary, secondary, and tertiary care. Integrated care is increasingly promoted for people with complex needs and has also recently been promoted in maternity care systems to improve the quality of care. Especially when located near an obstetric unit, birth centres are considered to be ideal settings for the realization of integrated care. At present, however, we know very little about the degree of integration in these centres and we do not know if increased levels of integration improve the quality of the care delivered. The Dutch Birth Centre Study is designed to evaluate birth centres and their contribution to the Dutch maternity care system. The aim of this particular sub-study is to classify birth centres in clusters with similar characteristics based on integration profiles, to support the evaluation of birth centre care.
This study is based on the Rainbow Model of Integrated Care. We used a survey followed by qualitative interviews in 23 birth centres in the Netherlands to determine which integration profiles can be distinguished and to describe their discriminating characteristics. Cluster analysis was used to classify the birth centres.
Birth centres were classified into three clusters: 1)"Mono-disciplinary-oriented birth centres" (n = 10): which are mainly owned by primary care organizations and established as physical facilities to provide an alternative birthplace for low risk births; 2) "Multi-disciplinary-oriented birth centres" (n = 6): which are mainly multi-disciplinary oriented and can be regarded as facilities to give birth, with a focus on integrated birth care; 3) "Mixed Cluster of birth centres" (n = 7): which have a range of organizational forms that differentiate them from centres in the other clusters.
We identified a recognizable classification, with similar characteristics between birth centres in the clusters. The results of this study can be used to relate integration profiles of birth centres to quality of care, costs, and perinatal outcomes. This assessment makes it possible to develop recommendations with regard to the type and degree of integration of Dutch birth centres in the future.
综合护理的目标是提供跨越公共卫生、初级、二级和三级护理界限的连续护理。综合护理越来越多地被推广用于有复杂需求的人群，最近也在孕产妇护理系统中得到推广，以提高护理质量。特别是当位于产科病房附近时，分娩中心被认为是实现综合护理的理想场所。然而，目前我们对这些中心的整合程度知之甚少，也不知道更高的整合水平是否能提高所提供护理的质量。荷兰分娩中心研究旨在评估分娩中心及其对荷兰孕产妇护理系统的贡献。这项特定子研究的目的是根据整合概况将分娩中心分类为具有相似特征的集群，以支持对分娩中心护理的评估。
本研究基于综合护理的彩虹模型。我们在荷兰的23个分娩中心进行了一项调查，随后进行了定性访谈，以确定可以区分哪些整合概况，并描述它们的区分特征。聚类分析用于对分娩中心进行分类。
分娩中心被分为三类：1）“以单一学科为导向的分娩中心”（n = 10）：主要由初级保健组织拥有，作为为低风险分娩提供替代分娩场所的实体设施；2）“以多学科为导向的分娩中心”（n = 6）：主要以多学科为导向，可以被视为分娩设施，侧重于综合分娩护理；3）“分娩中心混合集群”（n = 7）：具有一系列组织形式，使其与其他集群中的中心有所不同。
我们确定了一种可识别的分类，各集群中的分娩中心具有相似特征。本研究结果可用于将分娩中心的整合概况与护理质量、成本和围产期结局联系起来。这一评估使得未来能够就荷兰分娩中心的整合类型和程度提出建议。
