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

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.