Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK.
Clinical Quality, Royal College of Obstetrics and Gynaecologists, 10-18 Union Street, London, SE11GH, UK.
Sex Reprod Healthc. 2024 Jun;40:100971. doi: 10.1016/j.srhc.2024.100971. Epub 2024 Apr 18.
During the COVID-19 pandemic, rapid and heterogeneous changes were made to maternity care. Identification of changes that may reduce maternal health inequalities is a national priority. The aim of this project was to use data collected about care and outcomes to identify NHS Trusts in the UK where inequalities in outcomes reduced during the pandemic and explore through interviews how the changes that occurred may have led to a reduction in inequalities.
A Women's Reference Group of public advisors guided the project. Analysis of Hospital Episode Statistics Admitted Patient Care data of 128 organisations in England identified "positive deviant" organisations that reduced inequalities, using maternal and perinatal composite adverse outcome indicators. Positive deviant organisations were identified for investigation, alongside comparators. Senior clinicians, heads of midwifery and representatives of women giving birth were interviewed. Reflexive thematic analysis was employed.
The change in the inequality gap for the maternal indicator ranged from a reduction of -0.24 to an increase of 0.30 per 1000 births between the pre-pandemic and pandemic period. For the perinatal composite indicator, the change in inequality gap ranged from -0.47 to 0.67 per 1000 births. Nine Trusts were identified as positive deviants and 10 as comparators. We conducted 20 interviews from six positive deviant and four comparator organisations. Positive deviants reported that necessary shifts in roles led to productive and novel use of expert staff; comparators reported senior staff 'stepping in' where needed and no benefits of this. They reported proactivity and quick reactions, increased team working, and rapid implementation of new ideas. Comparators found constant changes overwhelming, and no increase in team working. No specific differences in care processes were identified.
Harnessing proactivity, flexibility, staffing resource, and increased team working proves vital in reducing health inequalities.
在 COVID-19 大流行期间，产妇保健迅速发生了多样化的变化。确定可能减少产妇健康不平等的变化是国家的优先事项。本项目的目的是利用收集到的护理和结果数据，确定英国国民保健制度信托中在大流行期间结果不平等减少的信托，并通过访谈探索发生的变化如何导致不平等减少。
一个由公众顾问组成的妇女参考小组指导了该项目。对英格兰 128 个组织的住院患者医疗数据的分析确定了减少不平等的“良性偏离”组织，使用产妇和围产期综合不良结局指标。对良性偏离组织进行了调查，并与对照组进行了比较。采访了高级临床医生、助产士负责人和分娩妇女的代表。采用了反思性主题分析。
在大流行前和大流行期间，产妇指标的不平等差距变化范围从每 1000 例分娩减少 0.24 到增加 0.30。对于围产期综合指标，不平等差距的变化范围从每 1000 例分娩减少 0.47 到增加 0.67。确定了 9 个信托作为良性偏离组织，10 个作为对照组。我们从六个良性偏离组织和四个对照组进行了 20 次访谈。良性偏离组织报告说，角色的必要转变导致了专家人员的富有成效和新颖的利用；对照组报告说，在需要时高级人员“介入”，但没有从中受益。他们报告说具有积极性和快速反应能力，增加了团队合作，迅速实施了新想法。对照组发现不断变化的情况令人不知所措，团队合作没有增加。没有确定护理过程中的具体差异。
利用积极性、灵活性、人员配置资源和增加团队合作对于减少健康不平等至关重要。
