Hattori Sanae, Sakata Nobuo, Ishimaru Miho, Tamiya Nanako
Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan.
Front Glob Womens Health. 2023 Apr 28;4:1030443. doi: 10.3389/fgwh.2023.1030443. eCollection 2023.
We examined the relationship between consolidation of delivery and the workload of obstetricians working at perinatal centers.
We conducted a descriptive analysis using perinatal care areas classified into three types (metropolitan, provincial, and rural). We calculated the Herfindahl-Hirschman Index (HHI) as an index of consolidation and the proportion of the deliveries at clinics as an indicator of the low-risk deliveries and the deliveries per center obstetrician as an indicator of obstetricians' workload. We used >150 deliveries yearly as an excess indicator. The correlation between the HHI and obstetricians' workload and the proportion of deliveries at clinics was examined using the Pearson correlation coefficient.
The proportion of areas with >150 deliveries yearly was higher in the consolidated areas. In provincial areas, obstetricians' workload was positively correlated with the HHI and was negatively correlated with the proportion of deliveries at clinics.
The obstetricians' workload may be increasing where more consolidation occurs. In provincial areas, the center obstetrician's workload could be reduced not only by consolidation but also by sharing the role of handling low-risk deliveries with clinics and hospitals with obstetric units other than perinatal centers.
我们研究了分娩集中化与围产期中心产科医生工作量之间的关系。
我们使用分为三种类型（大都市、省级和农村）的围产期护理区域进行了描述性分析。我们计算了作为集中化指标的赫芬达尔-赫希曼指数（HHI）以及诊所分娩比例作为低风险分娩指标，以及每个中心产科医生的分娩量作为产科医生工作量指标。我们将每年超过150例分娩作为超额指标。使用Pearson相关系数检验HHI与产科医生工作量以及诊所分娩比例之间的相关性。
每年分娩超过150例的区域比例在集中化区域更高。在省级区域，产科医生的工作量与HHI呈正相关，与诊所分娩比例呈负相关。
在分娩集中化程度更高的地方，产科医生的工作量可能会增加。在省级区域，不仅可以通过集中化，还可以通过与围产期中心以外设有产科单位的诊所和医院分担处理低风险分娩的角色来减轻中心产科医生的工作量。
