Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Division of Neonatology, Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Eur J Public Health. 2023 Apr 1;33(2):342-348. doi: 10.1093/eurpub/ckad013.
Population health monitoring, such as perinatal mortality and morbidity rankings published by the European Perinatal Health (EURO-PERISTAT) reports may influence obstetric care providers' decision-making and professional behaviour. We investigated short-term changes in the obstetric management of singleton term deliveries in the Netherlands following publication of the EURO-PERISTAT reports in 2003, 2008 and 2013.
We used a quasi-experimental difference-in-regression-discontinuity approach. National perinatal registry data (2001-15) was used to compare obstetric management at delivery in four time windows (1, 2, 3 and 5 months) surrounding publication of each EURO-PERISTAT report.
The 2003 EURO-PERISTAT report was associated with higher relative risks (RRs) for an assisted vaginal delivery across all time windows [RR (95% CI): 1 month: 1.23 (1.05-1.45), 2 months: 1.15 (1.02-1.30), 3 months: 1.21 (1.09-1.33) and 5 months: 1.21 (1.11-1.31)]. The 2008 report was associated with lower RRs for an assisted vaginal delivery at the 3- and 5-month time windows [0.86 (0.77-0.96) and 0.88 (0.81-0.96)]. Publication of the 2013 report was associated with higher RRs for a planned caesarean section across all time windows [1 month: 1.23 (1.00-1.52), 2 months: 1.26 (1.09-1.45), 3 months: 1.26 (1.12-1.42) and 5 months: 1.19(1.09-1.31)] and lower RRs for an assisted vaginal delivery at the 2-, 3- and 5-month time windows [0.85 (0.73-0.98), 0.83 (0.74-0.94) and 0.88 (0.80-0.97)].
This study showed that quasi-experimental study designs, such as the difference-in-regression-discontinuity approach, are useful to unravel the impact of population health monitoring on decision-making and professional behaviour of healthcare providers. A better understanding of the contribution of health monitoring to the behaviour of healthcare providers can help guide improvements within the (perinatal) healthcare chain.
人口健康监测，如欧洲围产期健康 (EURO-PERISTAT) 报告发布的围产期死亡率和发病率排名，可能会影响产科护理提供者的决策和专业行为。我们调查了 2003 年、2008 年和 2013 年发表 EURO-PERISTAT 报告后，荷兰单胎足月分娩的产科管理的短期变化。
我们使用了准实验性回归不连续差异方法。利用全国围产期登记数据（2001-15 年），比较了在 EURO-PERISTAT 报告发布前后四个时间窗口（1、2、3 和 5 个月）的分娩时产科管理情况。
2003 年 EURO-PERISTAT 报告与所有时间窗口的辅助阴道分娩的相对风险（RR）较高相关[RR（95%CI）：1 个月：1.23（1.05-1.45），2 个月：1.15（1.02-1.30），3 个月：1.21（1.09-1.33），5 个月：1.21（1.11-1.31）]。2008 年报告与 3 个月和 5 个月时间窗口的辅助阴道分娩 RR 较低相关[0.86（0.77-0.96）和 0.88（0.81-0.96）]。2013 年报告的发表与所有时间窗口的计划性剖宫产 RR 较高相关[1 个月：1.23（1.00-1.52），2 个月：1.26（1.09-1.45），3 个月：1.26（1.12-1.42），5 个月：1.19（1.09-1.31）]和 2 个月、3 个月和 5 个月时间窗口的辅助阴道分娩 RR 较低[0.85（0.73-0.98）、0.83（0.74-0.94）和 0.88（0.80-0.97）]。
本研究表明，准实验研究设计，如回归不连续差异法，可用于揭示人口健康监测对医疗保健提供者决策和专业行为的影响。更好地了解健康监测对医疗保健提供者行为的贡献，可以帮助指导（围产期）医疗保健链的改进。
