PDF(Pubmed)
Abstract：
OBJECTIVE: The Indonesian Healthcare Program starting in 2014 enabled access to healthcare delivery for large population groups. Guidance of usage, infrastructure and healthcare process development were the most challenging tasks during the implementation period. Due to the high social impact obstetric care and related quality assurance require evidence-based developmental strategies. This study aims for analysis of outcome and maternal health care utilization, as well as differences related to demographic and economic subgroups.
METHODS: For univariate group comparison ANOVA method was applied and combined with Scheffé procedure and Bonferoni correction for post-hoc tests. Meanwhile, multivariate approaches through regression analysis based on insurance reimbursement data antenatal, perinatal and postnatal care were performed at the province level. Maternal mortality (MMR) and stillbirth rates were used for outcome. Demographic characteristics, availability of obstetricians (SPOG), midwifes and healthcare infrastructure were included for their determinants.
RESULTS: Specialized hospital facilities (type A/B) for advanced care covered a large part of uncomplicated cases (~35%). Differences between insurance membership groups (poor, non-poor) were not seen. Availability of human resources (SPOG, midwifes) (R2 = 0.728; p<0.001) and rural setting (R2 = 0.288; p = 0.001) are correlated with reduced insufficient referral. Their presence within provinces was related to lower occurrence of complicated cases (R2 = 0.294; p = 0.001). However, higher SPOG rates within provinces were also related to high C-section rates (p<0.001). MMR and stillbirth rates can be predicted by availability of human resources and C-section rates explaining 49.0% of variance.
CONCLUSIONS: Improvement of perinatal outcome should focus on sufficient referral processes, availability of SPOG in provinces dominated by rural/remote demography and avoidance of overtreatment by high C-section rates. It is very important to regulate the education of obstetricians and gynecologists in Indonesia as well as distribution arrangements regarding to solve the problems with pregnancy complications in remote and rural areas.
METHODS: For univariate group comparison ANOVA method was applied and combined with Scheffé procedure and Bonferoni correction for post-hoc tests. Meanwhile, multivariate approaches through regression analysis based on insurance reimbursement data antenatal, perinatal and postnatal care were performed at the province level. Maternal mortality (MMR) and stillbirth rates were used for outcome. Demographic characteristics, availability of obstetricians (SPOG), midwifes and healthcare infrastructure were included for their determinants.
RESULTS: Specialized hospital facilities (type A/B) for advanced care covered a large part of uncomplicated cases (~35%). Differences between insurance membership groups (poor, non-poor) were not seen. Availability of human resources (SPOG, midwifes) (R2 = 0.728; p<0.001) and rural setting (R2 = 0.288; p = 0.001) are correlated with reduced insufficient referral. Their presence within provinces was related to lower occurrence of complicated cases (R2 = 0.294; p = 0.001). However, higher SPOG rates within provinces were also related to high C-section rates (p<0.001). MMR and stillbirth rates can be predicted by availability of human resources and C-section rates explaining 49.0% of variance.
CONCLUSIONS: Improvement of perinatal outcome should focus on sufficient referral processes, availability of SPOG in provinces dominated by rural/remote demography and avoidance of overtreatment by high C-section rates. It is very important to regulate the education of obstetricians and gynecologists in Indonesia as well as distribution arrangements regarding to solve the problems with pregnancy complications in remote and rural areas.
摘要：
目标：印度尼西亚的医疗保健计划始于2014年，为广大人群提供了医疗保健服务。使用指导,基础设施和医疗保健流程开发是实施期间最具挑战性的任务。由于社会影响很大，产科护理和相关的质量保证需要基于证据的发展策略。本研究旨在分析结果和孕产妇保健利用情况，以及与人口和经济亚组相关的差异。
方法：对于单变量组比较，应用ANOVA方法，并结合Scheffé程序和Bonferoni校正进行事后检验。同时,通过基于产前保险报销数据的回归分析的多变量方法，在省一级进行围产期和产后护理。产妇死亡率（MMR）和死胎率用于结局。人口特征，产科医生的可用性（SPOG），决定因素包括助产士和医疗保健基础设施。
结果：用于高级护理的专科医院设施（A型/B型）涵盖了大部分无并发症病例（约35％）。保险会员群体之间的差异(差，非穷人)没有看到。人力资源的可用性(SPOG，助产士）（R2=0.728；p<0.001）和农村地区（R2=0.288；p=0.001）与转诊不足减少相关。他们在各省的存在与复杂病例的发生率较低有关（R2=0.294；p=0.001）。然而,各省较高的SPOG率也与较高的剖腹产率相关(p<0.001).MMR和死胎率可以通过人力资源的可用性和剖腹产率来预测，这解释了49.0％的差异。
结论：围产期结局的改善应侧重于充分的转诊过程，在以农村/偏远人口统计为主的省份中，SPOG的可用性，并避免了高剖腹产率的过度治疗。规范印度尼西亚产科医生和妇科医生的教育以及解决偏远和农村地区妊娠并发症问题的分配安排非常重要。
方法：对于单变量组比较，应用ANOVA方法，并结合Scheffé程序和Bonferoni校正进行事后检验。同时,通过基于产前保险报销数据的回归分析的多变量方法，在省一级进行围产期和产后护理。产妇死亡率（MMR）和死胎率用于结局。人口特征，产科医生的可用性（SPOG），决定因素包括助产士和医疗保健基础设施。
结果：用于高级护理的专科医院设施（A型/B型）涵盖了大部分无并发症病例（约35％）。保险会员群体之间的差异(差，非穷人)没有看到。人力资源的可用性(SPOG，助产士）（R2=0.728；p<0.001）和农村地区（R2=0.288；p=0.001）与转诊不足减少相关。他们在各省的存在与复杂病例的发生率较低有关（R2=0.294；p=0.001）。然而,各省较高的SPOG率也与较高的剖腹产率相关(p<0.001).MMR和死胎率可以通过人力资源的可用性和剖腹产率来预测，这解释了49.0％的差异。
结论：围产期结局的改善应侧重于充分的转诊过程，在以农村/偏远人口统计为主的省份中，SPOG的可用性，并避免了高剖腹产率的过度治疗。规范印度尼西亚产科医生和妇科医生的教育以及解决偏远和农村地区妊娠并发症问题的分配安排非常重要。
