监管产科评分与临床结果和实践措施的比较:一项使用常规收集数据的观察性研究

IF 4.7 1区 医学 Q1 OBSTETRICS & GYNECOLOGY
Ian Henderson, Ipek Gurol-Urganci, Alissa Frémeaux, Alessandra Morelli, Kirstin Webster, Amar M. Karia, Fran Carroll, George Dunn, James Harris, Sam Oddie, Asma Khalil, Jan van der Meulen
{"title":"监管产科评分与临床结果和实践措施的比较:一项使用常规收集数据的观察性研究","authors":"Ian Henderson,&nbsp;Ipek Gurol-Urganci,&nbsp;Alissa Frémeaux,&nbsp;Alessandra Morelli,&nbsp;Kirstin Webster,&nbsp;Amar M. Karia,&nbsp;Fran Carroll,&nbsp;George Dunn,&nbsp;James Harris,&nbsp;Sam Oddie,&nbsp;Asma Khalil,&nbsp;Jan van der Meulen","doi":"10.1111/1471-0528.18188","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>To compare inspection-informed ratings of individual maternity units published by the Care Quality Commission (CQC) with clinical outcomes and practice measures.</p>\n </section>\n \n <section>\n \n <h3> Design</h3>\n \n <p>Observational study using linked national maternity and administrative hospital data.</p>\n </section>\n \n <section>\n \n <h3> Setting</h3>\n \n <p>The English NHS.</p>\n </section>\n \n <section>\n \n <h3> Population</h3>\n \n <p>Women with singleton pregnancies who gave birth at term, April 2018–March 2019.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Outcomes and practice measures were compared with ratings using hierarchical models and empirical Bayes estimates adjusted for case-mix and unit characteristics.</p>\n </section>\n \n <section>\n \n <h3> Main Outcome Measures</h3>\n \n <p>Severe maternal and severe neonatal morbidity. Practice measures included non-spontaneous birth (either caesarean birth before labour or the induction of labour) and intrapartum caesarean birth.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Of 501 719 included women, 39 930 (8.0%) gave birth in 11 units rated ‘outstanding’, 357 114 (71.2%) in 110 units rated ‘good’, and 104 675 (20.9%) in 35 units rated ‘requires improvement/inadequate’. Severe maternal morbidity did not vary by rating: 1.2% [95% confidence interval 0.87–1.5], 1.3% [1.1–1.4], and 1.0% [0.87–1.1], respectively (<i>p</i> = 0.59), nor did the risk of severe neonatal morbidity: 4.3% [3.3–5.6], 4.0% [3.6–4.5], and 3.4% [2.9–3.9], respectively (<i>p</i> = 0.48). There was no variation across the ratings in the rate of non-spontaneous birth (48.1% [42.2–53.9], 47.9% [46.4–49.4], and 47.9% [45.1–50.8], respectively; <i>p</i> = 0.87) nor intrapartum caesarean (16.8% [14.6–19.3], 16.6% [15.8–17.3], and 15.8% [14.9–16.7], respectively; <i>p</i> = 0.87).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>There was no association between ratings of maternity units published by the national healthcare regulator and clinical outcomes and practice measures derived from routinely collected data. Concerted action is urgently needed to improve the inspection-informed ratings of maternity services.</p>\n </section>\n </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 9","pages":"1285-1296"},"PeriodicalIF":4.7000,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18188","citationCount":"0","resultStr":"{\"title\":\"A Comparison of Regulatory Maternity Unit Ratings With Clinical Outcomes and Practice Measures: An Observational Study Using Routinely Collected Data\",\"authors\":\"Ian Henderson,&nbsp;Ipek Gurol-Urganci,&nbsp;Alissa Frémeaux,&nbsp;Alessandra Morelli,&nbsp;Kirstin Webster,&nbsp;Amar M. Karia,&nbsp;Fran Carroll,&nbsp;George Dunn,&nbsp;James Harris,&nbsp;Sam Oddie,&nbsp;Asma Khalil,&nbsp;Jan van der Meulen\",\"doi\":\"10.1111/1471-0528.18188\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Objective</h3>\\n \\n <p>To compare inspection-informed ratings of individual maternity units published by the Care Quality Commission (CQC) with clinical outcomes and practice measures.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Design</h3>\\n \\n <p>Observational study using linked national maternity and administrative hospital data.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Setting</h3>\\n \\n <p>The English NHS.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Population</h3>\\n \\n <p>Women with singleton pregnancies who gave birth at term, April 2018–March 2019.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Outcomes and practice measures were compared with ratings using hierarchical models and empirical Bayes estimates adjusted for case-mix and unit characteristics.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Main Outcome Measures</h3>\\n \\n <p>Severe maternal and severe neonatal morbidity. Practice measures included non-spontaneous birth (either caesarean birth before labour or the induction of labour) and intrapartum caesarean birth.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Of 501 719 included women, 39 930 (8.0%) gave birth in 11 units rated ‘outstanding’, 357 114 (71.2%) in 110 units rated ‘good’, and 104 675 (20.9%) in 35 units rated ‘requires improvement/inadequate’. Severe maternal morbidity did not vary by rating: 1.2% [95% confidence interval 0.87–1.5], 1.3% [1.1–1.4], and 1.0% [0.87–1.1], respectively (<i>p</i> = 0.59), nor did the risk of severe neonatal morbidity: 4.3% [3.3–5.6], 4.0% [3.6–4.5], and 3.4% [2.9–3.9], respectively (<i>p</i> = 0.48). There was no variation across the ratings in the rate of non-spontaneous birth (48.1% [42.2–53.9], 47.9% [46.4–49.4], and 47.9% [45.1–50.8], respectively; <i>p</i> = 0.87) nor intrapartum caesarean (16.8% [14.6–19.3], 16.6% [15.8–17.3], and 15.8% [14.9–16.7], respectively; <i>p</i> = 0.87).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>There was no association between ratings of maternity units published by the national healthcare regulator and clinical outcomes and practice measures derived from routinely collected data. Concerted action is urgently needed to improve the inspection-informed ratings of maternity services.</p>\\n </section>\\n </div>\",\"PeriodicalId\":50729,\"journal\":{\"name\":\"Bjog-An International Journal of Obstetrics and Gynaecology\",\"volume\":\"132 9\",\"pages\":\"1285-1296\"},\"PeriodicalIF\":4.7000,\"publicationDate\":\"2025-05-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18188\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Bjog-An International Journal of Obstetrics and Gynaecology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/1471-0528.18188\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Bjog-An International Journal of Obstetrics and Gynaecology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/1471-0528.18188","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0

摘要

比较护理质量委员会(CQC)公布的个别产科单位的检查通知评级与临床结果和实践措施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

A Comparison of Regulatory Maternity Unit Ratings With Clinical Outcomes and Practice Measures: An Observational Study Using Routinely Collected Data

A Comparison of Regulatory Maternity Unit Ratings With Clinical Outcomes and Practice Measures: An Observational Study Using Routinely Collected Data

Objective

To compare inspection-informed ratings of individual maternity units published by the Care Quality Commission (CQC) with clinical outcomes and practice measures.

Design

Observational study using linked national maternity and administrative hospital data.

Setting

The English NHS.

Population

Women with singleton pregnancies who gave birth at term, April 2018–March 2019.

Methods

Outcomes and practice measures were compared with ratings using hierarchical models and empirical Bayes estimates adjusted for case-mix and unit characteristics.

Main Outcome Measures

Severe maternal and severe neonatal morbidity. Practice measures included non-spontaneous birth (either caesarean birth before labour or the induction of labour) and intrapartum caesarean birth.

Results

Of 501 719 included women, 39 930 (8.0%) gave birth in 11 units rated ‘outstanding’, 357 114 (71.2%) in 110 units rated ‘good’, and 104 675 (20.9%) in 35 units rated ‘requires improvement/inadequate’. Severe maternal morbidity did not vary by rating: 1.2% [95% confidence interval 0.87–1.5], 1.3% [1.1–1.4], and 1.0% [0.87–1.1], respectively (p = 0.59), nor did the risk of severe neonatal morbidity: 4.3% [3.3–5.6], 4.0% [3.6–4.5], and 3.4% [2.9–3.9], respectively (p = 0.48). There was no variation across the ratings in the rate of non-spontaneous birth (48.1% [42.2–53.9], 47.9% [46.4–49.4], and 47.9% [45.1–50.8], respectively; p = 0.87) nor intrapartum caesarean (16.8% [14.6–19.3], 16.6% [15.8–17.3], and 15.8% [14.9–16.7], respectively; p = 0.87).

Conclusions

There was no association between ratings of maternity units published by the national healthcare regulator and clinical outcomes and practice measures derived from routinely collected data. Concerted action is urgently needed to improve the inspection-informed ratings of maternity services.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
CiteScore
10.90
自引率
5.20%
发文量
345
审稿时长
3-6 weeks
期刊介绍: BJOG is an editorially independent publication owned by the Royal College of Obstetricians and Gynaecologists (RCOG). The Journal publishes original, peer-reviewed work in all areas of obstetrics and gynaecology, including contraception, urogynaecology, fertility, oncology and clinical practice. Its aim is to publish the highest quality medical research in women''s health, worldwide.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信