Rosenblatt R A, Macfarlane A, Dawson A J, Cartlidge P H, Larson E H, Hart L G
Department of Family Medicine, Seattle 98195-5304, USA.
Am J Public Health. 1996 Jul;86(7):1011-5. doi: 10.2105/ajph.86.7.1011.
The purpose of this study was to compare perinatal regionalization and neonatal mortality in Wales and Washington State.
The 28 hospitals in Wales and the 80 hospitals in Washington State that offered maternity services and the 218,326 births that occurred in these hospitals in 1989 and 1990 were studied. Surveys were used to identify the neonatal technology and the referral policies of each hospital, and linked data from birth and death certificates were used to examine birthweight-specific neonatal mortality rates for all babies born in these hospitals.
Welsh district general hospitals (broadly equivalent to Level II perinatal centers in the United States) have more sophisticated neonatal technology than their Washington State counterparts and appear less likely to refer small or preterm babies to regional or subregional centers. Neonatal mortality rates were quite similar in the two settings.
Perinatal care in Wales appears to be less regionalized than in a similar region in the United States. The relative lack of perinatal regionalization in Wales may contribute to duplication and underutilization of expensive neonatal technologies. National health care systems do not, in and of themselves, lead to optimal regionalization of services.
本研究旨在比较威尔士和华盛顿州的围产期区域化及新生儿死亡率。
对威尔士的28家提供产科服务的医院、华盛顿州的80家提供产科服务的医院以及在1989年和1990年这些医院发生的218,326例分娩进行了研究。通过调查确定每家医院的新生儿技术和转诊政策，并使用出生证明和死亡证明的关联数据来检查这些医院出生的所有婴儿的按出生体重划分的新生儿死亡率。
威尔士的地区综合医院（大致相当于美国的二级围产期中心）拥有比华盛顿州同类医院更先进的新生儿技术，而且似乎不太可能将低体重或早产婴儿转诊至地区或次区域中心。两种情况下的新生儿死亡率相当相似。
威尔士的围产期护理似乎不如美国类似地区那样区域化。威尔士围产期区域化相对不足可能导致昂贵的新生儿技术重复配置和利用不足。国家医疗保健系统本身并不会导致服务的最佳区域化。
