上海市全覆盖孕产期保健管理及其效果

本文总结了自2007年下发《上海市产科质量管理要求》的文件以来,上海市产科质量管理的具体做法和经验,包括孕产妇系统管理的加强,建立针对危重孕产妇的报告制度、会诊和转诊制度、抢救"绿色通道",加强孕产妇死亡的调查与评审,建立问责制与再培训制度等。此外,还总结了成功的经验及提出对进一步改进全覆盖孕产期保健的思考。     

上海市血液透析质量管理的措施和效果

总结了7年来上海市血液透析质量管理工作情况，介绍了上海市血透质控具体措施，包括：建立组织构架：加强从业人员管理：规范血透室布局；消毒隔离管理：患者管理；制定质控标准：定期质量督查。同时介绍了通过质控管理后所取得的显著成效，包括血透室布局符合率提高．肝炎病毒感染率下降并控制，患者死亡率降低．血透质量提高。此外，对今后血透持续质量改进工作提出建议。     

加强孕产妇规范管理 提高产科质量

桐乡市通过加强三级网建设；加强人才培养，提高业务素质；高目标，严要求，措施配套等措施，强化了孕产妇规范化管理，提高了产科质量，降低了孕产妇和围产儿死亡率。     

泰和县农村孕产妇死亡原因分析及其干预措施

目的：回顾性分析江西泰和县20年孕产妇死亡原因，探讨降低农村孕产妇死亡率的措施。方法：通过三级保健网收集泰和县1988—2007年的孕产妇死亡资料，按每10年一个阶段分析死亡原因，进行对比。结果：第二阶段的孕产妇死亡率较第一阶段明显下降，第一阶段孕产妇死亡原因主要是产科出血，其次是羊水栓塞，再就是妊娠高血压疾病，而妊娠合并症位居第4；第二阶段孕产妇死亡主要原因仍然是产科出血，妊娠高血压疾病跃居第2；妊娠合并症跃居第3；而羊水栓塞位居第11。结论：加强妇幼保健网的建设及孕产妇系统管理．规范缩宫素药物的应用，提高产科质量及住院分娩率．降低孕产妇的死亡率。     

宜昌市94例孕产妇死亡原因分析

目的：探讨宜昌市1998～2003年孕产妇死亡原因及相关因素。方法：对宜昌市1998～2003年94例孕产妇死亡的病例资料进行总结分析。结果：宜昌市6年孕产妇死亡率平均为57．50／10万．其主要原因是产科出血，占60．64％，其中以胎盘因素为多(59．65％)；其次是妊娠合并内科病和妊娠高血压综合征。结论：降低孕产妇死亡率涉及到社会、经济、文化、交通、医疗、保健及政府的投入等诸多因素。同时专业人员应该随着社会改革的新形式需要．调整思路，大胆创新，进一步加强孕产妇系统管理．特别是高危孕产妇的专案管理,提倡住院分娩,开辟急救通道．重视产科质量，注重提高产科人员的综合抢救能力．完善妇幼保健保偿机制，扩大、巩固和提高妇幼卫生队伍的素质，对基层医务人员进行适宜技术的再培训，是降低孕产妇死亡率的重要保证。     

76例孕产妇死亡原因分析与干预措施探讨

孕产妇死亡率是衡量一个国家或地区的社会经济、文化、医疗卫生及妇幼保健水平的重要综合性指标之一，减少孕产妇死亡是妇女保健工作的一个重要组成部分。对我市1987年至2002年76例孕产妇死亡原因作回顾性分析，并试图探讨减少孕产妇死亡的干预措施。15年间共有76例孕产妇死亡。孕产妇死亡原因中，以直接产科原因为主占73．69％；产科出血是孕产妇死亡的首要原因，占全部死亡的43．42％。第二位是心脏病：死亡孕产妇中，接受保健措施不够、未接受过产前检查及未达到产前检查要求的分别占17．11％、42．11％。有52．63％的孕产妇死于家中和转诊途中。孕产妇死亡中，产后死亡多于产前，前者占76．32％。对此，提出下列措施：(1)加强妇幼保健知识的宣传，提高群众的自我保健意识；(2)做好图产保健系统管理，加强对高危产妇的筛查，监测管理、推广适宜技术；(3)提高产科人员的业务水平，提高产科质量，狠抓产科出血的防治；(4)认真做好《母婴保健法》的贯彻落实工作，提高住院分娩率。呼吁全社会重视、支持妇幼保健工作，加强落实各项措施，孕产妇死亡是可以避免的。     

丽水山区孕产妇管理现状及对策分析

文章从丽水山区孕产妇管理现状入手，认为影响孕产妇安全的主要原因是：政府职能部门缺乏强有力的行政干预措施；妇幼经费投入仍不足；孕产妇保健和产科质量原因；服务对象的经济困难等问题。提出降低孕产妇死亡、保障母婴安全的措施和对策。     

汕头市2001～2003年孕产妇死亡情况分析

目的：为掌握我市孕产妇死亡状况，分析构成孕产妇死亡的相关因素，为干预措施提供依据。方法：2001～2003年汕头市三级保健网上报的妇幼卫生统计报表，孕产妇死亡报告卡、漏报调查表和城区孕产妇死亡监测等资料，经质量控制及死亡评审，对结果进行分析：结果：200l～2003年孕产妇死亡率分别为16．10／10万、14．04／10万、13．97／10万。孕产妇死亡前三位死因依次为产科出血、羊水栓塞、妊高征：外来人口孕产妇死亡占全市死亡总数50％。结论：3年中孕产妇死亡率呈逐年下降趋势，产科出血死因居首，外来人口孕产妇死亡偏高。应重点加强对外来人口孕产妇保健管理的应对措施，提高产科出血抢救技术，有效的降低孕产妇死亡率，提高母婴健康水平。     

渭南市1989—1998年孕产妇死因分析

目的：渭南市孕产妇死亡率十年来下降缓慢，呈上下波动趋势，为了研究分析渭南市孕产妇死亡率及死因变化规律，查找失误及教训，方法；对渭南市十一个县1989-1998年十年孕产妇死亡原因进行回顾分析。结果：造成该市孕妇死亡的主要疾病是产科出血，内科合并症，妊高征，产褥感染，羊水栓塞，主要死因和影响因素有孕期保健，产科质量，主要死因和影响因素有孕期保健，产科质量，住院分娩等，结论：今后应着重做好妊娠合并症的筛查与治疗，提高产科质量，认真实施产妇分级管理制度等项工作。     

湖北省产科质量调查结果分析及对策

对湖北省各级医疗保健机构产科质量进行调查。结果显示：在产科总床位数中，妇幼保健院占１３．２０％，综合医院占４０．０４％，乡镇卫生院占４６．７６％，每名产科医护人员管理床位数平均为１．０６张，高级职称构成，综合医院为７．９６％，妇幼保健院为６．３６％，乡镇卫生院为０．５７％；８２４所机构中，设有专用产房的机构有４５６所，占５５．３４％，各类设备中除Ｂ超、开放暖箱综合医院和妇幼保健院拥有率超过５０％，其余设备拥有率基本在５０％以下，乡镇卫生院各类设备拥有率只占１０％左右；院内孕产妇死亡率及围产儿死亡率均以县级妇幼保健院和乡镇卫生院为高；剖宫产率为１３．５３％。为进一步提高产科质量，提出以下措施：改善医疗保健机构基础设施和设备条件；提高产科医护人员的业务素质和技术水平，树立以病人为中心的服务意识；加强乡镇卫生院产科建设，提高医院分娩率；开展健康教育，提高孕产妇自我保健能力；加强《母婴保健法》执法力度，依法保障母婴健康；规范与产科质量相关数据的收集和整理     

Family-centered obstetrics in Hungary]

The author has carried out a survey at hospitals in Hungary to examine how general family-centred obstetrics is, and to what extent obstetrics departments are able to meet the increasing demand for this exerted by society. In the course of the survey he focused on the characteristics of obstetrics departments, the preparation for delivery and maternity, open delivery-rooms, delivery with the partner, early mother-baby contact and rooming-in, and to what extent these operate. He describes the findings on the basis of data returned by 87 maternity departments, 81.3% of the total number of institutions in the country. The data reveals that 96.6% of wards have preparatory courses for delivery and maternity, 98.8% of open-delivery rooms welcome the partner at the delivery, early mother-baby contact is possible in 97.7% and 95.6% offer rooming-in. The study gives a comprehensive view of the present state of family-centred obstetrics offering an opportunity for everyone to re-evaluate their practices and to set up new objectives so that every mother and family can have easy access to family-centred obstetrics.     

百色市2011年妇幼卫生信息管理质量控制结果分析

目的通过对百色市2011年妇幼卫生信息管理进行质量控制分析,总结妇幼信息的采集、录入、汇总等成功管理经验,找出差距,确保妇幼卫生信息数据的准确性,为制定妇幼卫生信息管理制度提供科学依据,也为进一步做好妇幼卫生保健工作提出可行性建议。方法对百色市2011年妇幼卫生信息管理主要相关结果指标和信息管理方式进行质量控制分析。结果活产数、5岁以下儿童死亡数两个指标存在漏报,围产儿死亡数、孕产妇死亡数、出生缺陷数3个指标无漏报;除新生儿破伤风发生数指标的符合率达到质控要求为100%,其余新生儿苯丙酮尿症筛查、新生儿甲状腺功能减低症筛查等16个指标的上报数据与登记本记录数据的符合率还有差距;县(区)、乡(镇)妇幼卫生信息管理质量控制还需加强;两个手册使用率不高,填写还达不到规范要求;广西妇幼卫生信息管理系统的日常数据交换不及时。结论加强妇幼卫生信息网络队伍建设,加大对信息人员培训力度,结合基本公共卫生项目,妇幼信息人员工作与绩效考评挂钩,按照妇幼卫生信息监测管理和《广西自治区妇幼卫生年报表质量检查方法》的要求,做好质控,利用广西妇幼卫生信息管理系统、《广西孕产妇保健手册》和《广西儿童保健手册》等,做好妇幼信息数据的录入、登记,利用市妇幼保健院的网站,做好妇幼信息数据的交换,确保妇幼卫生信息数据及时、准确和完整。     

Informal patient payments in maternity hospitals in Kiev,Ukraine

Maternity care in Ukraine is a government priority. However, it has not undergone substantial changes since the collapse of the Soviet Union. Similar to the entire health care sector in Ukraine, maternity care suffers from inefficient funding, which results in low quality and poor access to services. The objective of this paper is to explore the practice of informal payments for maternity care in Ukraine, specifically in cases of childbirth in Kiev maternity hospitals. The paper provides an ethnographic study on the consumers' and providers' experiences with informal payments. The results suggest that informal payments for childbirth are an established practice in Kiev maternity hospitals. The bargaining process between the pregnant woman (incl. her partner) and the obstetrician is an important part of the predelivery arrangement, including the informal payment. To deal with informal payments in Kiev maternity hospitals, there is a need for the following: (i) regulation of the “quasi‐official” patient payments at the health care facility level; and (ii) improvement of professional ethics through staff training. These strategies should be coupled with improved governance of the health care sector in general, and maternity care in particular in order to attain international quality standards and adequate access to facilities. Copyright © 2012 John Wiley & Sons, Ltd.     

The impact on neonatal mortality of shifting childbirth services among levels of hospitals: Taiwan's experience

Background  

There is considerable discussion surrounding whether advanced hospitals provide better childbirth care than local community hospitals. This study examines the effect of shifting childbirth services from advanced hospitals (i.e., medical centers and regional hospitals) to local community hospitals (i.e., clinics and district hospitals). The sample population was tracked over a seven-year period, which includes the four months of the 2003 severe acute respiratory syndrome (SARS) epidemic in Taiwan. During the SARS epidemic, pregnant women avoided using maternity services in advanced hospitals. Concerns have been raised about maintaining the quality of maternity care with increased demands on childbirth services in local community hospitals. In this study, we analyzed the impact of shifting maternity services among hospitals of different levels on neonatal mortality and maternal deaths.     

六西格玛管理法对妇产科优质护理病房护理质量、成本管理的影响研究

目的：分析六西格玛管理法对妇产科优质护理病房护理质量、成本管理的影响。方法选择在本院妇产科优质护理病房接受治疗的不同时期患者作为研究对象,分别接受常规管理及六西格玛管理法,观察两组病历书写时间、医嘱处理时间、护理质量、满意度、住院时间、住院费用。结果观察组病历书写时间（65．32±6．57）min、医嘱处理时间（135．24±12．05）min,明显低于对照组;护理质量（95．62±7．54）、患者满意度（92．15±8．76）、护士满意度（94．44±10.21）、单日费用（900．97±135．64）,明显高于对照组。结论六西格玛管理法能够减少护士间接工作时间,提高护理质量,增加床位利用率,实现医、患双赢的目的。     

广州市10年产科质量分析

目的:对10年来广州市产科质量相关指标进行分析,客观地反映产科业务水平、学科发展状况,为提高产科服务质量提供依据。方法:对2000～2009年度广州市产科质量报表相关指标进行动态分析。结果:分娩并发症及新生儿并发症发生率在逐年缓慢下降;围产儿死亡率持续下降;绝大部分高危妊娠结局良好;剖宫产率持续升高的同时阴道助产率却急速下降;产后出血和新生儿窒息仍是首位产、儿科的并发症;结论:10年来广州市产科医院分娩量在不断攀升的同时产科质量也在逐年提高,需要关注的问题有流动人口孕产妇管理必须重视;防治产后出血和新生儿窒息复苏技术培训需进一步加强;必须采取有效措施控制过高的剖宫产率。     

基于DEA-Tobit模型的县级妇幼保健院效率评价研究

目的对湖北省36家县级妇幼保健院的效率进行分析和评价,研究其发展存在的问题和不足,为提高县级妇幼保健院的效率提供参考。方法采用DEA-BCC模型和DEA-Malmquist模型对县级妇幼保健院的静态效率和动态效率进行分析,并利用Tobit回归分析其效率的影响因素。结果2015-2017年湖北省县级妇幼保健院总体技术效率较低,且内部间存在较大差异,但3年间全要素生产效率逐年递增;医护比、门诊住院比等因素对效率有显著影响。结论县级妇幼保健院有较大的发展空间,管理者应对其进行现代化科学的管理和规划,加强医疗团队建设,减少不必要住院次数,完善医疗资源的合理利用。     

郑州市68例产科出血导致孕产妇死亡原因分析

目的分析郑州市2004-2011年产科出血导致的孕产妇死亡,提出干预措施,以降低孕产妇死亡率。方法回顾性分析2004-2011年郑州市产科出血孕产妇死亡资料。结果 68例产科出血导致的孕产妇死亡占全部孕产妇死亡的32.08%,农村孕产妇占35.76%;在县乡级医院分娩者占75.0%,非住院分娩占17.65%;导致产科出血的因素中宫缩乏力占61.77%,居首位,其次为子宫破裂、软产道裂伤及胎盘因素,各占11.76%;无指征滥用催产药物及经产妇产科出血死亡者居多。结论居住农村、基层医院产科处理能力不足、经产妇及非住院分娩是产科出血死亡的重要因素。加强基层产科建设及业务培训,提高产科质量,积极处理第三产程,适时转诊,多科室合作,构建产科危重症的救治中心,可有效降低产科出血所致的孕产妇死亡率。     

Hospital practices in maternity wards in Lebanon

This study was conducted in Lebanon with the main objectives of acquiring baseline data on practices and routines applied in the obstetrics ward for women having normal delivery; estimating the frequency of certain practices; and assessing whether women are given choice in these practices. A national sample of 39 hospitals was selected. The director, head midwife, or head nurse of the obstetrics department was interviewed using a semi-structured questionnaire. The hospitals studied are largely equipped to cope with emergencies and services are available 24 hours a day. On average, the caesarean section rate is 18% and the stillbirth rate is 10 per 1000, but with considerable variability between facilities. The majority of hospitals do not have written policies or standard birth procedures and lack mechanisms for evaluation. Generally, minimal prenatal information is given to women. Companions are allowed during labour but this access is more restricted in delivery. The reported configuration of professional care during labour and delivery is favourable to high quality care. In terms of mobility during labour, most hospitals allow women to move. However, 31 hospitals set an i.v. drip to all women and some use continuous fetal monitoring method. Mobility is restricted in delivery; in 23 hospitals women are tied down. Nearly all hospitals give intra-muscular anaesthesia whereas epidurals are used less frequently. As for postpartum care, most hospitals do not initiate breastfeeding within one hour of birth and few have rooming in. The majority of hospitals do not provide women with family planning methods and a few do not even discuss methods with them. The approach used in this study constitutes a tool for understanding and assessing maternity services that should be applied in other settings. The tool is available from the authors.     

Improved obstetric safety through programmatic collaboration

Healthcare safety and quality are critically important issues in obstetrics, and society, healthcare providers, patients and insurers share a common goal of working toward safer practice, and are continuously seeking strategies to facilitate improvements. To this end, 4 New York City voluntary hospitals with large maternity services initiated a unique collaborative quality improvement program. It was facilitated by their common risk management advisors, FOJP Service Corporation, and their professional liability insurer, Hospitals Insurance Company. Under the guidance of 4 obstetrics and gynecology departmental chairmen, consensus best practices for obstetrics were developed which included: implementation of evidence based protocols with audit and feedback; standardized educational interventions; mandatory electronic fetal monitoring training; and enhanced in‐house physician coverage. Each institution developed unique safety related expertise (development of electronic documentation, team training, and simulation education), and experiences were shared across the collaborative. The collaborative group developed robust systems for audit of outcomes and documentation quality, as well as enforcement mechanisms. Ongoing feedback to providers served as a key component of the intervention. The liability carrier provided financial support for these patient safety innovations. As a result of the interventions, the overall AOI for our institutions decreased 42% from baseline (January–June 2008) to the most recently reviewed time period (July–December 2011) (10.7% vs 6.2%, p < 0.001). The Weighted Adverse Outcome Score (WAOS) also decreased during the same time period (3.9 vs 2.3, p = 0.001.) Given the improved outcomes noted, our unique program and the process by which it was developed are described in the hopes that others will recognize collaborative partnering with or without insurers as an opportunity to improve obstetric patient safety.