Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns Allen Research Institute, Los Angeles, CA; Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA.
Childbirth Research Associates, North Hollywood, CA.
Am J Obstet Gynecol. 2019 Feb;220(2):201.e1-201.e19. doi: 10.1016/j.ajog.2018.10.093. Epub 2018 Nov 4.
Under value-based payment programs, patient-reported experiences and outcomes can impact hospital and physician revenue. To enable obstetrical providers to improve the childbirth experience, a framework for understanding what women expect and desire during childbirth is needed.
The purpose of this study was to identify key predictors of childbirth hospital satisfaction with the use of the Childbirth Experiences Survey.
This study builds on a larger effort that used Patient-Reported Outcomes Management Information System methods to develop a childbirth-specific preliminary patient-reported experiences and outcomes item bank. These efforts led to the development of an antepartum and postpartum survey (Childbirth Experiences Survey Parts 1 and 2). All phases of the study were conducted with the participation of a community-based research team. We conducted a prospective observational study using national survey response panels that was organized through Nielsen to identify women's antepartum values and preferences for childbirth (Childbirth Experiences Survey Part 1). Eligible participants were pregnant women in the United States (English or Spanish speaking) who were ≥18 years old and ≥20 weeks pregnant. Women were recontacted and invited to participate in a postpartum follow-up survey to collect information about their childbirth patient-reported experiences and outcomes, which included childbirth satisfaction (Childbirth Experiences Survey Part 2). In bivariate analyses, we tested whether predisposing conditions (eg, patient characteristics or previous experiences), values and preferences, patient-reported experiences and outcomes, and the "gaps" between values and preferences and patient-reported experiences and outcomes were predictors of women's satisfaction with hospital childbirth services. Multivariable logistic regression models were fitted to examine the simultaneous effect of predictors on hospital satisfaction, which were adjusted for key predisposing conditions.
From 500 women who anticipated a vaginal delivery at the time of the antepartum survey, who labored before delivery, and who answered the postpartum survey, key findings included the following responses: (1) the strongest predictors of women's satisfaction with hospital childbirth services were items in the domains of staff communication, compassion, empathy, and respect, and (2) 23 childbirth-specific patient-reported experiences and outcomes were identified. Examples of these patient-reported experiences and outcomes (such as being told about progress in labor and being involved in decisions regarding labor pain management) appeared especially relevant to women who experienced childbirth. A final model that predicted women's satisfaction with hospital childbirth services included a total of 8 items that could be optimized by doctors, midwives, and hospitals. These included the patient's report of how well she coped with labor pain, whether the hospital provided adequate space and food for their support person, and whether she received practical support for feeding the newborn infant.
This study identified 23 childbirth-specific patient-reported experiences and outcomes that were predictors of childbirth hospital satisfaction. The implementation of the Childbirth Experiences Survey Parts 1 and 2 in a multihospital setting may lead to the development of childbirth hospital performance measures and strategies for improvement of the childbirth experience.
在基于价值的支付计划下，患者报告的体验和结果可能会影响医院和医生的收入。为了使产科服务提供者能够改善分娩体验，需要一个了解女性在分娩期间期望和需求的框架。
本研究的目的是使用分娩体验调查来确定分娩医院满意度的关键预测因素。
本研究是在一项使用患者报告结果管理信息系统方法开发特定于分娩的患者报告体验和结果初步项目库的更大努力的基础上进行的。这些努力导致了产前和产后调查（分娩体验调查第 1 部分和第 2 部分）的发展。研究的所有阶段都在一个以社区为基础的研究团队的参与下进行。我们进行了一项前瞻性观察性研究，使用全国调查响应面板，该面板是通过尼尔森组织的，以确定女性对分娩的产前价值观和偏好（分娩体验调查第 1 部分）。合格的参与者是美国（讲英语或西班牙语）的孕妇，年龄≥18 岁，怀孕≥20 周。对这些女性进行了重新联系并邀请她们参加产后随访调查，以收集有关她们分娩患者报告体验和结果的信息，其中包括分娩满意度（分娩体验调查第 2 部分）。在单变量分析中，我们测试了是否存在预测因素（例如患者特征或先前的经验）、价值观和偏好、患者报告的体验和结果，以及价值观和偏好与患者报告的体验和结果之间的“差距”是否是女性对医院分娩服务满意度的预测因素。多变量逻辑回归模型用于检查预测因素对医院满意度的综合影响，这些因素针对关键预测因素进行了调整。
从 500 名在产前调查时预计进行阴道分娩、分娩前进行分娩且回答产后调查的女性中，关键发现包括以下回答：（1）影响女性对医院分娩服务满意度的最强预测因素是员工沟通、同情心、同理心和尊重领域的项目，（2）确定了 23 项特定于分娩的患者报告体验和结果。这些患者报告体验和结果的例子（例如，被告知分娩进展情况以及参与分娩疼痛管理决策）似乎与经历分娩的女性特别相关。一个最终的模型预测了女性对医院分娩服务的满意度，其中包括总共 8 个项目，医生、助产士和医院可以优化这些项目。其中包括患者对自己如何应对分娩疼痛的报告、医院为其支持人员提供的足够空间和食物，以及他们是否获得了喂养新生儿的实际支持。
本研究确定了 23 项特定于分娩的患者报告体验和结果，这些结果是分娩医院满意度的预测因素。在多医院环境中实施分娩体验调查第 1 部分和第 2 部分可能会导致制定分娩医院绩效衡量标准和改善分娩体验的策略。
