Department of Social Statistics and Demography, University of Southampton, Southampton, UK.
Faculty of Medicine, Health & Life Sciences, Swansea University Medical School, Swansea University, Swansea, UK.
BMC Health Serv Res. 2023 Jun 22;23(1):675. doi: 10.1186/s12913-023-09669-0.
The COVID-19 pandemic has resulted in profound and far-reaching impacts on maternal and newborn care and outcomes. As part of the ASPIRE COVID-19 project, we describe processes and outcome measures relating to safe and personalised maternity care in England which we map against a pre-developed ASPIRE framework to establish the potential impact of the COVID-19 pandemic for two UK trusts.
We undertook a mixed-methods system-wide case study using quantitative routinely collected data and qualitative data from two Trusts and their service users from 2019 to 2021 (start and completion dates varied by available data). We mapped findings to our prior ASPIRE conceptual framework that explains pathways for the impact of COVID-19 on safe and personalised care.
The ASPIRE framework enabled us to develop a comprehensive, systems-level understanding of the impact of the pandemic on service delivery, user experience and staff wellbeing, and place it within the context of pre-existing challenges. Maternity services experienced some impacts on core service coverage, though not on Trust level clinical health outcomes (with the possible exception of readmissions in one Trust). Both users and staff found some pandemic-driven changes challenging such as remote or reduced antenatal and community postnatal contacts, and restrictions on companionship. Other key changes included an increased need for mental health support, changes in the availability and uptake of home birth services and changes in induction procedures. Many emergency adaptations persisted at the end of data collection. Differences between the trusts indicate complex change pathways. Staff reported some removal of bureaucracy, which allowed greater flexibility. During the first wave of COVID-19 staffing numbers increased, resolving some pre-pandemic shortages: however, by October 2021 they declined markedly. Trying to maintain the quality and availability of services had marked negative consequences for personnel. Timely routine clinical and staffing data were not always available and personalised care and user and staff experiences were poorly captured.
The COVID-19 crisis magnified pre-pandemic problems and in particular, poor staffing levels. Maintaining services took a significant toll on staff wellbeing. There is some evidence that these pressures are continuing. There was marked variation in Trust responses. Lack of accessible and timely data at Trust and national levels hampered rapid insights. The ASPIRE COVID-19 framework could be useful for modelling the impact of future crises on routine care.
COVID-19 大流行对母婴保健和结局产生了深远而广泛的影响。作为 ASPIRE COVID-19 项目的一部分，我们描述了与在英格兰进行安全和个性化产妇保健相关的流程和结果衡量标准，并将其与预先制定的 ASPIRE 框架进行对比，以确定 COVID-19 大流行对两个英国信托基金的潜在影响。
我们采用混合方法系统范围的案例研究，使用 2019 年至 2021 年期间来自两个信托基金及其服务用户的定量常规收集数据和定性数据（开始和完成日期因可用数据而异）。我们将研究结果映射到我们之前的 ASPIRE 概念框架，该框架解释了 COVID-19 对安全和个性化护理的影响途径。
ASPIRE 框架使我们能够全面、系统地了解大流行对服务提供、用户体验和员工福利的影响，并将其置于先前存在的挑战背景下。产妇服务在核心服务覆盖范围方面经历了一些影响，但信托级别的临床健康结果没有受到影响（在一个信托基金中可能有例外，即再入院）。用户和员工都发现一些大流行驱动的变化具有挑战性，例如远程或减少的产前和社区产后联系，以及限制陪伴。其他关键变化包括对心理健康支持的需求增加、家庭分娩服务的可用性和利用率的变化以及引产程序的变化。在数据收集结束时，许多紧急适应措施仍然存在。信托基金之间的差异表明了复杂的变化途径。员工报告说，官僚作风有所减少，这使得灵活性更大。在 COVID-19 第一波期间，员工人数增加，解决了一些大流行前的短缺问题：然而，到 2021 年 10 月，员工人数显著下降。试图维持服务的质量和可用性对人员产生了明显的负面影响。并非总是有及时的常规临床和人员配备数据，个性化护理和用户及员工体验也没有得到很好的记录。
COVID-19 危机放大了大流行前的问题，特别是人员配备水平低的问题。维持服务对员工的健康福祉造成了重大损失。有一些证据表明，这些压力仍在继续。信托基金的反应存在明显差异。信托基金和国家层面缺乏可访问和及时的数据阻碍了快速洞察。ASPIRE COVID-19 框架可用于模拟未来危机对常规护理的影响。
