教育项目和决策工具对选择产科医院的影响：分娩决策随机临床试验。

Impact of an educational program and decision tool on choice of maternity hospital: the delivery decisions randomized clinical trial.

机构信息

Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA, 02115, 617-432-3905, US.

Ovia Health, Boston, MA, US.

出版信息

BMC Pregnancy Childbirth. 2022 Oct 10;22(1):759. doi: 10.1186/s12884-022-05087-y.

DOI:10.1186/s12884-022-05087-y

PMID:36217115

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9549827/

Abstract

BACKGROUND

Reducing cesarean rates is a public health priority. To help pregnant people select hospitals with lower cesarean rates, numerous organizations publish publically hospital cesarean rate data. Few pregnant people use these data when deciding where to deliver. We sought to determine whether making cesarean rate data more accessible and understandable increases the likelihood of pregnant people selecting low-cesarean rate hospitals.

METHODS

We conducted a 1:1 randomized controlled trial in 2019-2021 among users of a fertility and pregnancy mobile application. Eligible participants were trying to conceive for fewer than five months or were 28-104 days into their pregnancies. Of 189,456 participants approached and enrolled, 120,621 participants met entry criteria and were included in analyses. The intervention group was offered an educational program explaining the importance of hospital cesarean rates and an interactive tool presenting hospital cesarean rates as 1-to-5-star ratings. Control group users were offered an educational program about hospital choice and a hospital choice tool without cesarean rate data. The primary outcome was the star rating of the hospital selected by each patient during pregnancy. Secondary outcomes were the importance of cesarean rates in choosing a hospital and delivery method (post-hoc secondary outcome).

RESULTS

Of 120,621 participants (mean [SD] age, 27.8 [7.9]), 12,284 (10.2%) reported their choice of hospital during pregnancy, with similar reporting rates in the intervention and control groups. Intervention group participants selected hospitals with higher star ratings (2.52 vs 2.16; difference, 0.37 [95% CI, 0.32 to 0.43] p < 0.001) and were more likely to believe that the hospitals they chose would impact their chances of having cesarean deliveries (38.5% vs 33.1%, p < 0.001) but did not assign higher priority to cesarean delivery rates when choosing their hospitals (76.2% vs 74.3%, p = 0.05). There was no difference in self-reported cesarean rates between the intervention and control groups (31.4% vs 31.4%, p = 0.98).

CONCLUSION

People offered an educational program and interactive tool to compare hospital cesarean rates were more likely to use cesarean data in selecting a hospital and selected hospitals with lower cesarean rates but were not less likely to have a cesarean.

CLINICAL TRIAL REGISTRATION

Registered December 9, 2016 at clinicaltrials.gov, First enrollment November 2019. ID NCT02987803, https://clinicaltrials.gov/ct2/show/NCT02987803.

摘要

背景

降低剖宫产率是公共卫生的重点。为了帮助孕妇选择剖宫产率较低的医院，许多组织都会公布医院的剖宫产率数据。但很少有孕妇在选择分娩地点时会使用这些数据。我们旨在确定提供更容易获取和理解的剖宫产率数据是否会增加孕妇选择低剖宫产率医院的可能性。

方法

我们于 2019 年至 2021 年期间在一个生育和妊娠移动应用程序的用户中进行了一项 1:1 的随机对照试验。合格的参与者是正在尝试怀孕不到五个月或怀孕 28-104 天的人。在接触和入组的 189456 名参与者中，有 120621 名符合入组标准并纳入分析。干预组提供了一个关于医院剖宫产率重要性的教育计划和一个将医院剖宫产率呈现为 1 到 5 星级评级的互动工具。对照组用户提供了一个关于医院选择的教育计划和一个没有剖宫产率数据的医院选择工具。主要结局是每位患者在怀孕期间选择的医院的星级评分。次要结局是剖宫产率在选择医院和分娩方式中的重要性（事后次要结局）。

结果

在 120621 名参与者（平均[SD]年龄 27.8[7.9]岁）中，有 12284 名（10.2%）报告了他们在怀孕期间选择的医院，干预组和对照组的报告率相似。干预组参与者选择了星级评分较高的医院（2.52 对 2.16；差异，0.37 [95%CI，0.32 至 0.43]；p<0.001），并且更有可能认为他们选择的医院会影响他们进行剖宫产的机会（38.5%对 33.1%，p<0.001），但在选择医院时并没有将剖宫产率的优先级更高（76.2%对 74.3%，p=0.05）。干预组和对照组的自我报告剖宫产率没有差异（31.4%对 31.4%，p=0.98）。