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, 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","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, 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\",\"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}
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.
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.