The Impact of Patient and Hospital Characteristics on the Quality of Maternity Care: Measure of Low Birthweight Delivery

病人背景與醫院特質對懷孕婦女醫療品質之影響：以嬰兒出生體重不足為指標

邱冠斌(Kuanpin Philip Chiu)

《中華行政學報》 1期 (2002/10) Pp. 85-149

https://doi.org/10.6712/JCPA.200210_(1).0005

摘要

醫療服務的消費者、提供者與研究學者越來越重視如何衡量醫療品質。本文以嬰兒出生體重不足為指標來衡量懷孕婦女的醫療品質。
本研究採用美國1995年16個州576所醫院的懷孕婦女抽樣病例，以多變數對數迴歸分析法預測病人背景、醫院特質與病人原有的健康問題對懷孕婦女醫療品質的影響。
本研究發現男嬰出生體重不足的機率低於女嬰。黑人占嬰充出生體重不足的比例高於白人，而西語裔占嬰兒出生體重不足的比例低於白人。投保貧民保險與未投保任何健康保險的婦女比投保自費健康保險的婦女更有可能生下體重不足的嬰兒。
就醫院特質而言，都市的醫院接生嬰兒體重不足的比例高於鄉村的醫院。教學醫院比非教學醫院更有可能接生體重不足的嬰兒。在營利性醫院出生的嬰兒體重不足的機率低於在公立醫院出生的嬰兒，而非營利性醫院接生嬰兒體重不足的比例與公立醫院相同。設置嬰兒加護病房的醫院比沒有嬰兒加護病房的醫院更有可能接生體重不足的嬰兒。
本研究也發現病人原有的健康問題的確對懷孕婦女的醫療品質產生顯著的影響。

關鍵字

懷孕婦女醫療品質 ； 嬰兒出生體重不足 ； 病人背景 ； 醫院特質 ； 病人原有的健康問題 ； 醫療付費來源 ； 管理式醫療服務 ； 教學醫院 ； 營利性醫院 ； 嬰兒加護病房

並列摘要

Medical care professionals, consumers, and researchers are increasingly interested in finding methods to measure the quality of health care. In this paper the measure of the quality of maternity care: low birthweight delivery (to focus on the access to and use of prenatal care) is analyzed.
Using a database of maternity cases from 576 hospitals in 16 states for 1995, logistic regression equations predict the likelihood of the chosen quality indicator as a function of patient and hospital characteristics and preexisting clinical risk factors.
It is found that boys are less likely than girls to be low birthweight. Compared to whites, blacks are likelier to be low birthweight, while Hispanics are less likely to be low birthweight. Compared to the privately-insured, both Medicaid mothers and uninsured mothers are more likely to deliver low birthweight babies.
Urban hospitals admit more mothers with low birthweight deliveries than rural hospitals. Mothers discharged from teaching hospitals are more likely than those from nonteaching hospitals to deliver low birthweight babies. Compared with discharges from public hospitals, mothers discharged from for-profit hospitals are less likely to deliver low birthweight babies. Nonprofit hospitals do not differ from public hospitals on the chosen quality indicators. Mothers discharged from hospitals with a neonatal intensive care unit (NICU) are more likely to deliver low birthweight babies than those discharged from hospitals without an NICU.
In general, the clinical risk factors are particularly important in predicting the quality indicator of maternity care.

並列關鍵字

quality of maternity care ； low birthweight delivery ； patient and hospital characteristics ； clinical risk factors ； source of payment ； managed care ； teaching hospitals ； hospital ownership ； neonatal intensive ca

參考文獻

Abitbol, M. Maurice,Ivette Castillo,Udele B. Taylor,Burton L. Rochelson,Susan Shmoys,Alan G Monheit(1993).Vaginal Birth after Cesarean Section: the Patient`s Point of View.American Family Physician.47,129-134.

Abrams, Barbara(1993).Preventing Low Birth Weight: Does WIC Work?.Annals of the New York Academy of Sciences.678,306-316.

Agency for Health Care Policy and Research(1993).AHCPR Invites Proposals on Quality Improvement and Quality Assurance Research.Research Activities.165,11-12.

Alpert, Joel J.,Barry Zuckerman(1991).Alcohol Use during Pregnancy: What Is the Risk?.Pediatrics in Review.12,375-379.

Avruch, Sheila,Alicia P. Cackley(1995).Savings Achieved by Giving WIC Benefits to Women Prenatally.Public Health Reports.110,27-34.