关键词: Accessibility Centralization Closure Germany Obstetrics Regionalization

Mesh : Pregnancy Child Female Humans Health Services Accessibility Hospitals Hospital Departments Obstetrics Obstetrics and Gynecology Department, Hospital

来  源:   DOI:10.1186/s12913-023-09204-1

Abstract:
BACKGROUND: An increase in regionalization of obstetric services is being observed worldwide. This study investigated factors associated with the closure of obstetric units in hospitals in Germany and aimed to examine the effect of obstetric unit closure on accessibility of obstetric care.
METHODS: Secondary data of all German hospital sites with an obstetrics department were analyzed for 2014 and 2019. Backward stepwise regression was performed to identify factors associated with obstetrics department closure. Subsequently, the driving times to a hospital site with an obstetrics department were mapped, and different scenarios resulting from further regionalization were modelled.
RESULTS: Of 747 hospital sites with an obstetrics department in 2014, 85 obstetrics departments closed down by 2019. The annual number of live births in a hospital site (OR = 0.995; 95% CI = 0.993-0.996), the minimal travel time between two hospital sites with an obstetrics department (OR = 0.95; 95% CI = 0.915-0.985), the availability of a pediatrics department (OR = 0.357; 95% CI = 0.126-0.863), and population density (low vs. medium OR = 0.24; 95% CI = 0.09-0.648, low vs. high OR = 0.251; 95% CI = 0.077-0.822) were observed to be factors significantly associated with the closure of obstetrics departments. Areas in which driving times to the next hospital site with an obstetrics department exceeded the 30 and 40 min threshold slightly increased from 2014 to 2019. Scenarios in which only hospital sites with a pediatrics department or hospital sites with an annual birth volume of ≥ 600 were considered resulted in large areas in which the driving times would exceed the 30 and 40 min threshold.
CONCLUSIONS: Close distances between hospital sites and the absence of a pediatrics department at the hospital site associate with the closure of obstetrics departments. Despite the closures, good accessibility is maintained for most areas in Germany. Although regionalization may ensure high-quality care and efficiency, further regionalization in obstetrics will have an impact on accessibility.
摘要:
背景:在全球范围内观察到产科服务区域化的增加。这项研究调查了与德国医院产科关闭相关的因素,旨在研究产科关闭对产科护理可及性的影响。
方法:分析了2014年和2019年所有设有产科的德国医院的二级数据。进行后向逐步回归以确定与产科关闭相关的因素。随后,绘制了前往产科医院的开车时间,并对进一步区域化产生的不同方案进行了建模。
结果:在2014年拥有产科的747家医院中,到2019年有85家产科关闭。医院的年活产数量(OR=0.995;95%CI=0.993-0.996),两个有产科的医院站点之间的最小旅行时间(OR=0.95;95%CI=0.915-0.985),儿科的可用性(OR=0.357;95%CI=0.126-0.863),和人口密度(低与中等OR=0.24;95%CI=0.09-0.648,低与高OR=0.251;95%CI=0.077-0.822)被认为是与产科关闭显着相关的因素。从2014年到2019年,到下一个拥有产科的医院站点的开车时间超过30分钟和40分钟阈值的区域略有增加。仅考虑具有儿科的医院站点或年出生量≥600的医院站点的情况,导致驾驶时间超过30分钟和40分钟阈值的大面积区域。
结论:医院站点之间的距离较近以及医院站点没有儿科与产科关闭有关。尽管关闭,德国大部分地区都保持良好的可达性。尽管区域化可以确保高质量的护理和效率,产科的进一步区域化将对可及性产生影响.
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