Cada semana cuenta: uso de dispositivos sanitarios y costes relacionados de una cohorte comunitaria de personas con enfermedades crónicas avanzadas

ObjectiveTo describe the use of health resources of people with advanced chronicity, quantifying and characterizing its cost to suggest improvements in health care models.DesignObservational, analytical and prospective study during 3 years of a cohort of people with advanced chronicity.LocationThree primary care teams (EAP) of Osona, Cataluña.Participants224 people identified as advanced patients through a systematic population strategy.Main measurementsAge, sex, type of home, end-of-life trajectory; use, type and cost of resources in primary care, emergencies, palliative teams or hospitalization (in acute or intermediate care).ResultsPatients made an average of 1.1 admissions per year (average stay = 6 days), 74% in intermediate care hospitals. They lived in the community 93.4% of time, carrying out 1 weekly contact with the EAP (45.1% home care). The average daily cost was 19.4 euros, the main chapters were intermediate care hospitalizations (36.5%), EAP activity (29.4%) and admissions in acute hospitals (28.6%). Factors determining a potential lower cost are frailty/dementia as trajectory (p < 0.001), living in a nursing-home facility (p < 0.001) and over-aging (p < 0.001). There are certain differences in the behavior of the EAP related to the global cost and to community resources (p < 0.05).ConclusionsConsumption in intermediate hospitalization and primary care is more relevant than stays in acute care centers. Nursing-homes and home-care strategies are important to attend effectively and efficiently, especially when primary care teams get ready for it.     

Quality and usefulness of an anonymous unique personal identifier to link hospital stays recorded in French claims databases

BackgroundsSince 2001, the French national case mix program is allowed by law to use an enciphering algorithm named “FOIN” to produce a unique anonymous identifier in order to crosslink, within and across hospitals, discharge abstracts from a given patient. This algorithm “thrashes” the person's health insurance number, date of birth and gender. Before using information produced by the case mix program, either for case mix payment or for epidemiology research or for assessing care approaches, the quality of linkage must be evaluated.MethodsFoin error flags were first assessed in the 2002 Rhône-Alpes regional case mix database. Second, for the two university hospitals of Lyon and Saint-Etienne, double identifiers (two or more Foin identifiers for the same patient) and collisions (a single Foin identifier for at least two patients) were compared with others identifiers: administrative identifier and an anonymous identifier produced by Anonymat^® software from name, forename and date of birth. Third, Foin error flags are crossed with Foin double identifier or collision mistakes.ResultsFirst, among 1 668 971 hospital discharge abstracts from the regional case mix database, 206 710 (12.4%) had at least one Foin error flag. The most frequent error flag (93 026 [5.5%] stays) was due to the lack of the three identifying variables. The greatest number for error flags concerned the stays of newborns (38.5%) and those of public hospitals (17.3%). Second, Foin created a few double identifiers: 1.2% among 137 236 patients from university hospital of Lyon and 0.3% among 39 512 patients from university hospital of Saint-Etienne. The collisions concerned 7776 (5.7%) patients from Lyon and 460 (1.2%) from Saint-Etienne. The identifier produced by Anonymat performed better than the one produced by Foin: 99.6% from the two university hospitals. Third, less than 3% of stays without Foin error flag nevertheless had mistakes on Foin when compared with others identifiers.ConclusionThe overall assessment is not in favour of a quality threshold using the Foin identifier on a routine basis except in some areas and if certain activities like neonatology are excluded. There are several ways to improve the linkage of health data.     

Food insecurity and social protection in Europe: Quasi-natural experiment of Europe's great recessions 2004–2012

Food insecurity rose sharply in Europe after 2009, but marked variation exists across countries and over time. We test whether social protection programs protected people from food insecurity arising from economic hardship across Europe. Data on household food insecurity covering 21 EU countries from 2004 to 2012 were taken from Eurostat 2015 edition and the Organisation for Economic Cooperation and Development. Cross-national first difference models were used to evaluate how rising unemployment and declining wages related to changes in the prevalence of food insecurity and the role of social protection expenditure in modifying observed effects. Economic hardship was strongly associated with greater food insecurity. Each 1 percentage point rise in unemployment rates was associated with an estimated 0.29 percentage point rise in food insecurity (95% CI: 0.10 to 0.49). Similarly, each $1000 decreases in annual average wages was associated with a 0.62 percentage point increase in food insecurity (95% CI: 0.27 to 0.97). Greater social protection spending mitigated these risks. Each $1000 spent per capita reduced the associations of rising unemployment and declining wages with food insecurity by 0.05 percentage points (95% CI: − 0.10 to − 0.0007) and 0.10 (95% CI: − 0.18 to − 0.006), respectively. The estimated effects of economic hardship on food insecurity became insignificant when countries spent more than $10,000 per capita on social protection. Rising unemployment and falling wages are strong statistical determinants of increasing food insecurity, but at high levels of social protection, these associations could be prevented.     

Pediatric epidemic crisis: Lessons for policy and practice development

ObjectivesIn Belgium, a prospective payment system (PPS) has been implemented for in-patient non-medical costs since 1995, aimed at improving efficiency in the management of in-patient stays. We analyze the hospital's response in terms of in-patient length of stay (LOS) and medical and surgical expenditures.MethodsWe use data for all Belgian in-patient discharges over the 1991–1998 period. In-patient stays are aggregated according to pathology, age, year and hospital. Estimates are obtained using panel data regressions with fixed effects.ResultsThe in-patient length of stay is significantly reduced after the reform. However, the impact is low in magnitude. In addition, medical and surgical expenditures increase, probably reflecting a profit-compensation effect, as medical and surgical services are paid by fee-for-service. Finally, hospitals receiving higher percentages of underprivileged cases, for which the financing scheme is not risk-adjusted, experience a larger decrease in length of stay in the years following the reform. This last finding may be the sign of patient's indirect selection.ConclusionThe reform towards more hospital financial responsibility did not allow achieve high reductions in resource use. The non-inclusion of medical services in the new financing and the imperfections of risk-adjustment may largely explain this finding.     

Lien précarité – durée et complexité des séjours hospitaliers en secteur de court séjour

BackgroundSeveral studies have shown that socioeconomic deprivation is associated with increased hospitalization lengths of stay (LOS) and costs. Yet, the French DRG-based information system (PMSI) does not take deprived situations into account. Hence, we aimed at extracting routinely available variables measuring deprivation from the Hospital Information System and at assessing their association with severity of illness and hospital LOS.MethodsWe performed record linkage between the PMSI database concerning stays of patients aged more than 16 years in the short-stay sector of Assistance publique–Hôpitaux de Paris in 2007 and an administrative database which provided the following deprivation measures: recipients of Couverture Médicale Universelle (basic or complementary health insurances adapted for underprivileged French citizens) or Aide Médicale d’État (health and medical emergency insurances adapted for underprivileged non French citizens living in France) and homeless patients. We compared length of stays showing a deprivation measure to others after adjustment on morbidity, age and sex.ResultsAmong 352,721 stays, the prevalence of the deprivation measures ranged from 0.71% for “homelessness” to 6.24% for complementary Couverture Médicale Universelle. Stays showing a deprivation measure had specific illnesses and had more frequently associated comorbidities or complications than others. After adjustment, deprivation measures were associated with significantly increased LOS (by 5% for Couverture Médicale Universelle to 48% for emergency Aide Médicale d’État.ConclusionRoutine extraction of deprivation measures from Hospital Information Systems is feasible. Age, sex and illness being equal, these deprivation measures were associated with more complicated cases and increased LOS. We recommend that case mix-based hospital prospective payment systems take socioeconomic deprivation into account.     

Providing personal informal care to older European adults: Should we care about the caregivers' health?

ObjectiveIn Europe, the demand for informal care is high and will increase because of the ageing population. Although caregiving is intended to contribute to the care recipient's health, its effects on the health of older European caregivers are not yet clear. This study explores the association between providing informal personal care and the caregivers' health.MethodData were used from the longitudinal cohort (2004/2005–2010/2011) of the Survey of Health, Ageing and Retirement in Europe (SHARE) (n = 7858). Generalized estimating equations were used to explore the longitudinal association of informal care and the caregiver's health using poor self-rated health (less than good), poor mental health (EURO-D score for depression ≥ 4), and poor physical health (≥ 2 health complaints).ResultsProviding informal personal care was significantly associated with poor mental health (OR = 1.23, 95% CI = 1.04–1.47) and poor physical health (OR = 1.18, 95% CI = 1.01–1.38), after adjusting for various socio-demographic and health-related factors. No statistical significant association was found for self-rated health in the adjusted models.ConclusionProviding informal personal care may negatively influence the caregiver's mental and physical health. More awareness of the beneficial and detrimental effects of caregiving among policy makers is needed to make well-informed decisions concerning the growth of care demands in the ageing population.     

Reduction in emergency department visits for children's asthma,ear infections,and respiratory infections after the introduction of state smoke-free legislation

Despite the benefits of smoke-free legislation on adult health, little is known about its impact on children's health. We examined the effects of tobacco control policies on the rate of emergency department (ED) visits for childhood asthma (N = 128,807), ear infections (N = 288,697), and respiratory infections (N = 410,686) using outpatient ED visit data in Massachusetts (2001 − 2010), New Hampshire (2001–2009), and Vermont (2002 − 2010). We used negative binomial regression models to analyze the effect of state and local smoke-free legislation on ED visits for each health condition, controlling for cigarette taxes and health care reform legislation. We found no changes in the overall rate of ED visits for asthma, ear infections, and upper respiratory infections after the implementation of state or local smoke-free legislation or cigarette tax increases. However, an interaction with children's age revealed that among 10–17-year-olds state smoke-free legislation was associated with a 12% reduction in ED visits for asthma (adjusted incidence rate ratios (aIRR) 0.88; 95% CI 0.83, 0.95), an 8% reduction for ear infections (0.92; 0.88, 0.97), and a 9% reduction for upper respiratory infections (0.91; 0.87, 0.95). We found an overall 8% reduction in ED visits for lower respiratory infections after the implementation of state smoke-free legislation (0.92; 0.87, 0.96). The implementation of health care reform in Massachusetts was also associated with a 6–9% reduction in all children's ED visits for ear and upper respiratory infections. Our results suggest that state smoke-free legislation and health care reform may be effective interventions to improve children's health by reducing ED visits for asthma, ear infections, and respiratory infections.     

Cervical cytology screening among low-income,minority adolescents in New York City following the 2009 ACOG guidelines

ObjectivesIn December 2009, the American College of Obstetricians and Gynecologists recommended that cervical cancer screening begin at age 21 for young women. In this study, we examine receipt of first lifetime Papanicolaou (Pap) test and predictors of over-screening among adolescents within a large urban ambulatory care network.MethodsWe compared the proportion of first lifetime Pap test of adolescents aged 13–20 years between June 2007 — November 2009 (n = 7700) and December 2009–June 2012 (n = 9637) using electronic health records. We employed multivariable regression models to identify demographic and health care factors associated with receiving a first lifetime Pap test at age < 21 years in the post-guideline period (over-screening).ResultsThe proportion of Pap tests declined from 19.3% to 4.2% (p < 0.001) between the two periods. Multivariable logistic regression results showed receiving care from gynecologic/obstetric/family planning clinics compared to pediatric clinics, having more clinic encounters, and older age were associated with over-screening in the post-guideline period.ConclusionsWe found that guideline adherence differed by clinic type, insurance status, and health care encounters. In the quickly evolving field of cervical cancer control, it is important to monitor practice trends as they relate to shifts in population-based guidelines, especially in high-risk populations.     

Evaluation of hospital stays linkage quality to study health spatial variation. a feasibility study in three French regions

BackgroundSince 2001, the French hospital stay databases (Programme de médicalisation des systèmes d’information, PMSI) have included a unique and anonymous identifier in order to cross-link discharge abstracts from a given patient, within and across hospitals. These data could be used to estimate prevalence for some diseases at a territorial level provided that linkage quality is good enough. Few morbidity data are available at this scale. This study analyzes the link between linkage quality and hospitalization rates in three French regions (Picardy, Brittany and Provence-Alpes-Côte d’Azur–Paca).MethodsWe studied short stays in medicine-chirurgical-obstetrical units for the 2004–2005 period (all stays, and stays with mention of cancer or asthma). To study linkage quality, the percentage of linkable stays (no error during the production of the anonymous identifier) was calculated at regional and territorial levels (areas used by regional health authorities). The interquartile range (IQR = third quartile – first quartile) of the percentage of linkable stays was calculated and the link between this percentage and standardized rates of people hospitalized at least once in 2004 or 2005 tested by Spearman correlation coefficients.ResultsFor all stays, percentages of linkable stays were 94.4%, 96.6% and 97.0% in Picardy, Paca and Brittany respectively in 2004–2005. Geographical variation at the territorial level was higher in Picardy (IQR between 4 and 6) than in the two other regions (IQR between 1 and 2). The percentage of linkable stays was positively and significantly associated with the hospitalization rate for all stays and those with mention of cancer in Picardy only.ConclusionAccording to these results, PMSI data earlier than 2006 should be used with precaution; linkage quality should be analyzed before making geographical or time comparisons of hospitalization rates. Comparisons cannot always be made. Other studies should be carried out in other regions, and to analyze recent trends in linkage quality.     

Évaluation des cinq premières années de gestion de la nutrition parentérale à domicile par un prestataire de services en région Limousin

The French region of Limousin uses since 2003 a health care provider for home parenteral nutrition (HPN). An evaluation of the first five years was performed in a retrospective manner, concerning 494 stays of 375 different patients, aged 60.9 ± 12.7 years, between January 1st, 2003 and December 31, 2007. Concerning the HPN, 77.5% were made for cancer patients, 49.7% had a C Detsky index and the average of Karnovsky index was 73.5. The nutrition used in 84.2% of cases an injection site. The three administrative departments of the region received 77.3% of stays. The comparative analysis showed that age of cancer patients was higher, their Detsky index was worse, their ingesta were lower, and that they died more frequently during their follow-up than patients with digestive non-cancer disease. The small follow-up duration in digestive non-cancer patients could be due to a recruitment in perioperative period for them, or could be linked with their need of only refeeding limited sequences. This activity of HPN with a health care provider was useful, answering to a large number of demands, particularly for cancer patients.     

Nutrition entérale à domicile : 3 millions de journées d’expérience

Willing to bring the most recent epidemiological data of an important number of patients receiving enteral nutrition at home (9427 patients for 13,662 being taken in charge, more than 3 million days), this work reviews the various chapters of the 2005 publication in order to update them and redefines the evolution after 23 years of cares. As such, recruitment of patients essentially through hospitals (80% of the patients), predominantly male (61.6%), with an average age of 63.6 years and the pathologies recorded (48.8% cancergenic and 39.5% neurological). Afterwards, the mode of administration are studied (55.2% of patients had a gastrostomy tube). The study then estimates the daily nutritional requirements to 1705 kcal for adults and 982 kcal for a child and the repartition of different enteral nutrition used (polymeric at 97.8% and semi-elementary at 2.2%). The different complications mostly digestive are listed, including the fate of the patients (40.3% of deaths, 31.9% of re-hospitalisation and 25.3% reverted per os) after an average length of support of 324 days shared among the recorded pathologies. The biological follow-up on certain patients reveal interesting data on plasma levels but most importantly, it enables rapid intervention in cases of major abnormalities. The financial implication of total care enteral nutrition at home with the decree of 2009 and 2010 is shown and the benefit of such home care is verified.     

Does hospital discharge policy influence sick-leave patterns in the case of female breast cancer?

The objective was to investigate how differences among hospitals in the shift from in-patient care to day surgery and a reduced hospital length of stay affect the sick-leave period for female patients surgically treated for breast cancer. All women aged 18-64 who were diagnosed with breast cancer in 2000 were selected from the National Cancer Register and combined with data from the sick-leave database of the National Social Insurance Board and the National Hospital Discharge Register (N = 1834). A multi-factorial model was fitted to the data to investigate how differences in hospital care practice affected the length of sick-leave. The main output measure was the number of sick-leave days after discharge during the year following surgery. The confounders used included age, type of primary surgical treatment, whether or not lymph node dissection was performed, labour-market status, county, and readmission. Women treated with breast-conserving surgery had a 54.7-day (-71.9 < or = CI(95%) < or = -37.5) shorter sick-leave period than those with more invasive surgery. The day-surgery cases had 24.3 (-47.5 < or = CI(95%) < or = -1.1) days shorter sick-leave than those who received overnight care. The effect of the hospital median length of stay (LOS) was U-shaped, suggesting that hospitals with a median LOS that is either short or long are associated with longer sick-leave. In the intermediate range, women treated in hospitals with a median LOS of 2 days had 22 days longer sick-leave than those treated in hospitals with a mean LOS of 3 days. This is possibly a sign of sub-optimising.     

Temporal association of rotavirus vaccination and genotype circulation in South Africa: Observations from 2002 to 2014

BackgroundRotavirus vaccination has reduced diarrhoeal morbidity and mortality globally. The monovalent rotavirus vaccine was introduced into the public immunization program in South Africa (SA) in 2009 and led to approximately 50% reduction in rotavirus hospitalization in young children. The aim of this study was to investigate the rotavirus genotype distribution in SA before and after vaccine introduction.Materials and methodsIn addition to pre-vaccine era surveillance conducted from 2002 to 2008 at Dr George Mukhari Hospital (DGM), rotavirus surveillance among children <5 years hospitalized for acute diarrhoea was established at seven sentinel sites in SA from April 2009 to December 2014. Stool specimens were screened by enzyme immunoassay and rotavirus positive specimens genotyped using standardised methods.ResultsAt DGM, there was a significant decrease in G1 strains from pre-vaccine introduction (34%; 479/1418; 2002–2009) compared to post-vaccine introduction (22%; 37/170; 2010–2014; p for trend <.001). Similarly, there was a significant increase in non-G1P[8] strains at this site (p for trend <.001). In expanded sentinel surveillance, when adjusted for age and site, the odds of rotavirus detection in hospitalized children with diarrhoea declined significantly from 2009 (46%; 423/917) to 2014 (22%; 205/939; p < .001). The odds of G1 detection declined significantly from 2009 (53%; 224/421) to 2010–2011 (26%; 183/703; aOR = 0.5; p < .001) and 2012–2014 (9%; 80/905; aOR = 0.1; p < .001). Non-G1P[8] strains showed a significant increase from 2009 (33%; 139/421) to 2012–2014 (52%; 473/905; aOR = 2.5; p < .001).ConclusionsRotavirus vaccination of children was associated with temporal changes in circulating genotypes. Despite these temporal changes in circulating genotypes, the overall reduction in rotavirus disease in South Africa remains significant.     

Facteurs sociodémographiques et recours aux soins pour raisons psychologiques chez les jeunes adultes

BackgroundAlthough young adults exhibit a high rate of psychiatric disorders, their rate of access to mental health care is low compared with older age groups. Our study examined the relationship between socio-demographic factors and the use of health care services for psychological reasons.MethodsWe studied a community sample of 1103 French 22 to 35-year-old (TEMPO cohort study) who were surveyed by mailed questionnaire in 2009. Data were collected regarding participants’ health (internalizing and externalizing psychological symptoms in 1991 and 2009), health care use (access to health professionals and psychotropic medications in case of psychological difficulties), and socio-demographic factors (sex, age, employment status, marital situation, social support). Parental history of depression was ascertained based on TEMPO participants’ and their parents’ reports (in the GAZEL cohort study).ResultsIn the 12 months preceding the study, 16.7% of study participants saw a health professional and 12.8% took a psychotropic medication for psychological reasons. In multivariate regression, models adjusted for all socio-demographic and psychological characteristics, access to health professionals was associated with being unemployed/out of the labor force (OR = 1.93; 95% CI = 1.11–3.30), family situation (OR in participants living with a partner with no children: 2.16; 95% CI 1.26–3.72; OR in participants not living with a partner: 2.29; 95% CI = 1.34–3.90), and having low social support (OR = 1.75; 95% CI = 1.21–2.54). The use of psychotropic medications was associated with female gender (OR = 2.70; 95% CI = 1.60–4.55), being unemployed/out of the labor force (OR = 3.85; 95% CI = 2.14–6.95), not living with a partner (OR = 2.04; 95% CI = 1.09–3.80) and having low social support (OR = 1.65; 95% CI = 1.05–2.59). Additionally, use of health services was associated with participants’ and their parents’ psychological difficulties.     

El gasto sanitario en España, 2002-2008: ¿empieza el rescate presupuestario de la atención primaria?

ObjectiveTo determine the distribution of the public health spending (PHS) among health sectors from 2002 to 2008, and the eventual regional inequalities related to the regional income level and the ageing population.DesignA longitudinal and retrospective study.SettingSpain.ParticipantsThe 17 Autonomous Communities.MethodsThe relationship between health expenditure and income and ageing population in the regions, their growth and participation in PHS was analysed.ResultsPrimary Care (PC) expenditure has increased 25% more than the PHS; hospital spending has grown 18% more than the PC and hospital staff spending has grown 5% more than the PC staff. Hospital participation in PHS is twice (10%) that of PC participation (5%). Hospital expenditure variables were positively correlated with income but barely, or negatively, with ageing population. PC expenditure variables were positively correlated with ageing but negative with income. The richest regions spend less on drugs (r = 0.56, p = 0.02), more on hospitals (r = 0.52, p = 0.03) but not more on PC (r = 0.07). Regions with more ageing populations spend more on PC (r = 0.39, P = .12) and drugs (r = 0.63, P < .01) but just more on hospitals (r = 0.15). The income level barely correlates with ageing population (r = 0.15).ConclusionsBetween 2002 and 2008 the differences detected during the previous years in the budget growth between hospitals and PC were reduced. The growth of spending on hospitals is higher than on PC, but this is higher than PHS. The centralising of care in hospitals is notable in the richest regions.     

Hospital response to prospective financing of in-patient days: the Belgian case

OBJECTIVES: In Belgium, a prospective payment system (PPS) has been implemented for in-patient non-medical costs since 1995, aimed at improving efficiency in the management of in-patient stays. We analyze the hospital's response in terms of in-patient length of stay (LOS) and medical and surgical expenditures. METHODS: We use data for all Belgian in-patient discharges over the 1991-1998 period. In-patient stays are aggregated according to pathology, age, year and hospital. Estimates are obtained using panel data regressions with fixed effects. RESULTS: The in-patient length of stay is significantly reduced after the reform. However, the impact is low in magnitude. In addition, medical and surgical expenditures increase, probably reflecting a profit-compensation effect, as medical and surgical services are paid by fee-for-service. Finally, hospitals receiving higher percentages of underprivileged cases, for which the financing scheme is not risk-adjusted, experience a larger decrease in length of stay in the years following the reform. This last finding may be the sign of patient's indirect selection. CONCLUSION: The reform towards more hospital financial responsibility did not allow achieve high reductions in resource use. The non-inclusion of medical services in the new financing and the imperfections of risk-adjustment may largely explain this finding.     

Health Insurance Discontinuities Among Adolescents Leaving Foster Care

PurposeTo determine whether adolescents who lose Medicaid entitlements when they leave foster care are subsequently able to secure employer-sponsored or student health insurance coverage.MethodsThis was a 2-year follow-up study of a cohort of 404 adolescents leaving foster care in eight counties in a midwestern state. We conducted survival analysis to study predictors of time to first insurance loss, and logistic regression analysis to determine factors associated with insurance reacquisition, among these youth.ResultsA total of 206 adolescents (51%) left foster care during follow up, of whom 138 (67%) lost health insurance coverage within a mean of 3 months of leaving foster care. Those who regained coverage (34; 17% of those leaving foster care) did so after a mean period of 8 months spent without insurance. Hazard of insurance loss was lower for employed adolescents (HR = .5; 95% CI = .4–.7; p < .0001), but only half of all adolescents leaving foster care reported being able to secure employment. Student health insurance did not reduce hazard of insurance loss. Boys had significantly lower odds of regaining insurance compared with girls (OR = .2, SE = .5, p = .003).ConclusionsMost youth leaving the child welfare system seem unable to transition to other forms of health insurance coverage. Even those that do acquire coverage, do so after an inordinate period of time. Enacting existing extensions of Medicaid coverage until age 21 for foster care youth is necessary to provide the resources to address the considerable health and mental health needs among these youth.     

Obstetric care in Mali: effect of organization on in-hospital maternal mortality

BackgroundMaternal mortality is still too high in sub-Saharan Africa, particularly in referral hospitals. Solutions exist but their implementation is a great issue in the poor-resources settings. The objective of this study is to assess the effect of the organization of obstetric care services on maternal mortality in referral hospitals in Mali.MethodsThis is a multicentric observational survey in 22 referral hospitals. Clinical data on 42,929 women delivering in the 22 hospitals within the 2007 to 2008 study period were collected. Organization evaluation was based on explicit criteria defined by an expert committee. The effect of the organization on in-hospital mortality adjusted on individual and institutional characteristics was estimated using multi-level logistic regression models.ResultsThe results show that an optimal organization of obstetric care services based on eight explicit criteria reduced in-hospital maternal mortality by 41% compared with women delivering in a referral hospital with sub-optimal organization defined as non-compliance with at least one of the eight criteria (ORa = 0.59; 95% CI = 0.34–0.92). Furthermore, local policies that improved financial access to emergency obstetric care had a significant impact on maternal outcome.ConclusionCriteria for optimal organization include the management of labor and childbirth by qualified personnel, an organization of human resources that allows timely management of obstetric emergencies, routine use of partography for all patients and availability of guidelines for the management of complications. These conditions could be easily implemented in the context of Mali to reduce in-hospital maternal mortality.     

Qué hacen los hospitales y la atención primaria para mitigar el impacto social de los eventos adversos graves

Objective

To explore what hospitals and primary care (PC) are doing to reduce the negative social impact of a serious adverse event (AE).