Division of Midwifery and Community Health, Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts.
Clinical Financial Planning and Decision Support, Baystate Health, Springfield, Massachusetts.
J Midwifery Womens Health. 2020 Jan;65(1):56-63. doi: 10.1111/jmwh.13010. Epub 2019 Jul 28.
Preventing a primary cesarean birth in nulliparous women with term, singleton, vertex pregnancies (NTSV) is recognized as an important strategy to reduce maternal morbidities and risks to the newborn. Multiple professional organizations are supporting approaches to safely reduce NTSV cesarean rates, including the American College of Obstetricians and Gynecologists; the Society for Maternal-Fetal Medicine; and the Association of Women's Health, Obstetric and Neonatal Nurses. The American College of Nurse-Midwives (ACNM) is leading one such effort as part of its Healthy Birth Initiative: the Reducing Primary Cesareans (RPC) Learning Collaborative. The objective of this study is to estimate the cost savings of a decrease in NTSV cesareans at one hospital participating in the RPC Learning Collaborative.
All women giving birth at Baystate Medical Center from October 1, 2016, to March 31, 2017, and their newborns were identified by Medicare Severity Diagnosis Related Group (N = 1747). Total hospital costs were calculated using a resource consumption profile for each of 6 groups: women who had vaginal birth, primary cesarean, and repeat cesarean and their linked newborns. A model was developed to estimate cost differences for the first and second births and overall cost savings.
For the NTSV birth, total costs for primary cesarean and newborn care were $5989 higher compared with vaginal birth and newborn care. For the subsequent birth, repeat cesareans and newborn care were $4250 higher compared with vaginal birth. In 2016, 69 primary cesareans were prevented, for an actual cost savings of $413,241. Projecting the prevention of 66 subsequent repeat cesareans would result in additional savings of $280,500, for a total savings of $693,741. Apgar score at 5 minutes and length of stay remained unchanged.
Participation in ACNM's RPC Learning Collaborative led to significant savings in hospital costs during the first year without affecting quality metrics. This cost comparison model could be replicated by other hospitals involved in cesarean reduction endeavors.
在无并发症的初产妇中预防足月、单胎、头位（NTSV）剖宫产被认为是减少产妇发病率和新生儿风险的重要策略。许多专业组织都支持采取安全措施来降低 NTSV 剖宫产率，其中包括美国妇产科医师学会；母胎医学学会；以及妇女健康、产科和新生儿护士协会。美国护理助产士学院（ACNM）正在领导一项这样的努力，作为其健康分娩倡议的一部分：减少主要剖宫产（RPC）学习合作。本研究的目的是估计参与 RPC 学习合作的一家医院 NTSV 剖宫产减少所带来的成本节约。
通过 Medicare 严重程度诊断相关组（N = 1747），确定 2016 年 10 月 1 日至 2017 年 3 月 31 日在 Baystate 医疗中心分娩的所有妇女及其新生儿。使用每个 6 组的资源消耗情况来计算总医院成本：阴道分娩、初次剖宫产和重复剖宫产的妇女及其新生儿。建立了一个模型来估计第一胎和第二胎的成本差异以及总体成本节约。
对于 NTSV 分娩，初次剖宫产和新生儿护理的总费用比阴道分娩和新生儿护理高 5989 美元。对于随后的分娩，重复剖宫产和新生儿护理比阴道分娩高 4250 美元。2016 年，预防了 69 例初次剖宫产，实际节省了 413241 美元。如果预计预防 66 例随后的重复剖宫产，将额外节省 280500 美元，总节省 693741 美元。阿普加评分 5 分钟和住院时间保持不变。
参与 ACNM 的 RPC 学习合作导致了第一年医院成本的显著节省，而没有影响质量指标。其他参与剖宫产减少工作的医院可以复制这种成本比较模型。
