Soins maternels intensifs (Maternal Intensive Care) en Belgique - KCE

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92 Maternal Intensive Care in Belgium KCE Reports 94 The high variability in intensity of use of MIC beds between maternities must be highlighted and related also to the number and proportion of intermediate care women cared for in non-MIC maternities (2 of which having a NIC unit). Every hospital with accredited MIC-beds receives an extra amount of money to pay for the FTE of midwives with experience in high-risk pregnancies (see point 1.2.5). This amount of money depends on the number of MIC-beds. Consequently, the effectiveness of MIC-services can notably be estimated using proxy-indicators like the number of IC women per MIC-bed and the number of transfers per MIC-bed. Following the R.D. (see point 1.1), MIC-service is dedicated to admission of patients were the baby most probably will need intensive care after delivery. The WENZ-study and NIC report emphasised that it is better to transfer the mother before the delivery (intra-uterine transfer), rather than to transfer the newborn after the delivery, when one can predict that the newborn will need neonatal intensive care as for example premature neonates (
KCE Reports 94 Maternal Intensive Care in Belgium 93 7 GENERAL DISCUSSION AND CONCLUSION 7.1 CONTEXT Any evaluation of the functioning of MIC in Belgium should basically translate into an evaluation of how well MIC-services fulfil their legally defined function. However, neither the Royal Decree on Maternal Intensive Care nor any consensus statements stipulate unambiguously the indicated use of MIC-services. This leaves admission patterns to a MIC-unit governed by practice rather than through formal admission criteria and referral pathways. Therefore, current utilization of MIC-care is a cause of concern as it remains unclear whether the levelling of maternal care as defined by the Royal Decree on Maternal Intensive Care serves the goals it was intended to, i.e. providing optimal maternal care in a cost-efficient way. 7.2 OBJECTIVES The primary objectives of this health services research project were to assess the effectiveness and the efficiency of the MIC function in Belgium and to assess the equity of access to MIC care. Determining the effectiveness of the MIC function in Belgium (research question 2) would basically entail an evaluation of the degree to which the MIC-services comply with their function as set out by the Royal Decree on the MIC function. Partly, the adequate use of the MIC function can be approximated by comparing real diseasespecific admission rates to the anticipated admission rates derived from a theoretical, expert-based model. The efficiency of the MIC function in Belgium (research question 3) relates to the proper use of resources allocated to maternity facilities with a MIC function. Therefore real disease-specific admission rates were compared to the anticipated admission rates derived from a theoretical, expert-based model, using various proxy-indicators of efficiency. Equity of access to MIC care in Belgium (research question 4) was approached through a geographical distribution of MIC-services, the proportion of women delivering in maternities with a MIC-service, the proportion of prematurely born babies in maternities with a MIC service and socio-economic indicators of patients admitted. It should be emphasized that the present study was not intended, nor designed, to measure the quality of maternity care. 7.3 ADEQUATE USE OF MIC-BEDS The women delivering in hospitals with a MIC-service show some statistically significant differences compared to the population in hospitals without a MIC-service: more women with premature babies or stillbirths, more multiple pregnancies, more socially deprived women (measured through available proxy variables) and a larger proportion of older women. For Belgium as a whole, a higher proportion of women with a low socio-economical status (defined as BIM or MAF) are delivering in hospitals with MIC service, although this difference is not statistically significant in all provinces separately. When comparing the characteristics of women (according to the recommended levels of care for the observed situation of admissions) in hospitals with and without MICservices, the concordance between expected versus observed levels of maternal care is relatively poor. However, an important finding was that, of all women who should theoretically have been allocated to intermediate care (according to the registered diagnosis), only 40% was actually admitted to a maternity with a MIC-service. This proportion of so-called ‘adequate use’ varies widely across provinces, from as low as 15.5% in the province of Namur up to 64.1% in the province of Liege. In other words, in Belgium 60% of women considered to require intermediate care currently do not deliver in maternity services intended to provide such care.
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35. Etude relative aux coûts poten
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Soins maternels intensifs (Maternal Intensive Care) en Belgique - KCE

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