Koller Daniela, Maier Werner, Lack Nicholas, Grill Eva, Strobl Ralf
Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, Marchioninistr. 15, 81377, Munich, Germany.
Bavarian Institute for Quality Assurance, Munich, Germany.
Res Health Serv Reg. 2024 May 9;3(1):7. doi: 10.1007/s43999-024-00041-1.
The choice of a hospital should be based on individual need and accessibility. For maternity hospitals, this includes known or expected risk factors, the geographic accessibility and level of care provided by the hospital. This study aims to identify factors influencing hospital choice with the aim to analyze if and how many deliveries are conducted in a risk-appropriate and accessible setting in Bavaria, Germany.
This is a cross-sectional secondary data analysis based on all first births in Bavaria (2015-18) provided by the Bavarian Quality Assurance Institute for Medical Care. Information on the mother and on the hospital were included. The Bavarian Index of Multiple Deprivation 2010 was used to account for area-level socioeconomic differences. Multiple logistic regression models were used to estimate the strength of association of the predicting factors and to adjust for confounding.
We included 195,087 births. Distances to perinatal centers were longer than to other hospitals (16 km vs. 12 km). 10% of women with documented risk pregnancies did not deliver in a perinatal center. Regressions showed that higher age (OR 1.03; 1.02-1.03 95%-CI) and risk pregnancy (OR 1.44; 1.41-1.47 95%-CI) were associated with choosing a perinatal center. The distances travelled show high regional variation with a strong urban-rural divide.
In a health system with free choice of hospitals, many women chose a hospital close to home and/or according to their risks. However, this is not the case for 10% of mothers, a group that would benefit from more coordinated care.
医院的选择应基于个人需求和可及性。对于妇产医院而言，这包括已知或预期的风险因素、地理可及性以及医院提供的护理水平。本研究旨在确定影响医院选择的因素，以分析在德国巴伐利亚州，有多少分娩是在风险适配且可及的环境中进行的。
这是一项横断面二次数据分析，基于巴伐利亚州医疗质量保证研究所提供的巴伐利亚州所有头胎分娩数据（2015 - 2018年）。纳入了母亲和医院的信息。使用2010年巴伐利亚多重贫困指数来考量地区层面的社会经济差异。采用多重逻辑回归模型来估计预测因素的关联强度并调整混杂因素。
我们纳入了195,087例分娩。到围产期中心的距离比到其他医院的距离更长（16公里对12公里）。有记录的风险妊娠妇女中有10%未在围产期中心分娩。回归分析表明，年龄较大（比值比1.03；95%置信区间为1.02 - 1.03）和风险妊娠（比值比1.44；95%置信区间为1.41 - 1.47）与选择围产期中心相关。出行距离存在很大的地区差异，城乡差距明显。
在一个可自由选择医院的医疗体系中，许多女性根据自身风险选择了离家近的医院。然而，10%的母亲并非如此，这部分人群将受益于更协调的护理。
