Mcknoulty Matthew J, Martin Elizabeth K
Metro North Health, Queensland Health, University of Queensland, Brisbane, Queensland, Australia.
Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.
Aust N Z J Obstet Gynaecol. 2025 Apr;65(2):212-217. doi: 10.1111/ajo.13883. Epub 2024 Sep 27.
This study aimed to evaluate the costs and consequences of a new midwife-navigator-facilitated care pathway for reduced fetal movements.
This study was conducted at a tertiary obstetric centre in Queensland, Australia and modelling occurred for this and smaller services. Two months of data from pre (n = 112 in 2019) and post (n = 141 in 2020) implementation of the care pathway were analysed with T-tests and logistic regression models to evaluate maternal and neonatal outcomes. A Markov model was built to estimate the costs and consequences of the intervention. Sensitivity analysis was conducted to test various scenarios including modelling for smaller centres.
There were no statistically significant differences in clinical outcome between the intervention and usual care groups. Intervention patients spent one hour and eight minutes less time in hospital (P < 0.001). This resulted in a saving to the centre of AU$135 per patient (AU$159 083 annually). One-way sensitivity analysis suggested that cost savings would be found in all scenarios except for smaller units providing services for less than 1900 births per annum.
CONCLUSION(S): To our knowledge, no other care pathway involving acute obstetric care has been economically evaluated to date. Our model based on real-world presentations for reduced fetal movements confirms that midwife-navigators may be an economically beneficial implementation strategy for dealing with common obstetric conditions.
本研究旨在评估一种由助产士导航员推动的、针对胎动减少的新护理路径的成本和效果。
本研究在澳大利亚昆士兰州的一家三级产科中心进行，并针对该中心及规模较小的服务机构进行了模型构建。对护理路径实施前（2019年，n = 112）和实施后（2020年，n = 141）两个月的数据进行了T检验和逻辑回归模型分析，以评估母婴结局。构建了一个马尔可夫模型来估计干预措施的成本和效果。进行了敏感性分析，以测试各种情景，包括为较小中心构建模型。
干预组和常规护理组的临床结局在统计学上无显著差异。干预组患者的住院时间减少了1小时8分钟（P < 0.001）。这使得该中心每位患者节省了135澳元（每年节省159,083澳元）。单向敏感性分析表明，除了每年分娩少于1900例的较小单位提供服务的情景外，在所有情景中均可实现成本节约。
据我们所知，迄今为止尚未对涉及急性产科护理的其他护理路径进行经济评估。我们基于胎动减少的实际病例构建的模型证实，助产士导航员可能是应对常见产科情况的一种具有经济益处的实施策略。
