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

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94 Maternal Intensive Care in Belgium KCE Reports 94 Two types of referrals to a MIC-service are observed, either during a hospitalization (transfer from one hospital to another) or during pregnancy (referral from an outpatient clinic). These transfers or referrals are either initiated by the women or by the gynaecologist. There are no data about referrals occurring before hospitalisation. Among the 97 718 pregnant women in our database, merely 1073 (1.02%) were transferred from one hospital to another of which 660 transfers (61.5%) occurred before the delivery (intrauterine transfer) and 413 transfers (38.5.1%) took place after delivery. Among the intrauterine transfers, 510 (77.3%) occurred towards maternities with a MIC-service, while 22.7% of intra-uterine transfers were towards a maternity without MIC because some isolated maternities without MIC-beds also receive those transfers (RMST fff and CHR-Namur ggg ). Maternities belonging to teaching hospitals received the highest proportions of transfer per MIC-bed (> 10%), except for maternities in Brussels (local competition or referral rate ?). 7.4 PROVISION OF SERVICES ADEQUACY Every hospital with MIC-beds receives extra financial support to pay for midwives experienced in high-risk pregnancies. The additional MIC-budget is worth 2.29 points (or €46 347.54) per MIC-bed (physician fees not included). Because the administrative and financial registration of the MIC-activities does not discriminate between M- and MIC-beds, we do not have specific financial data on MIC-beds as currently the Belgian hospitals register MIC-beds similarly as they do M-beds. We first compared two indices to measure MIC-bed use: (1) the MIC/(M+MIC) bed ratio reflects the proportion for a given MIC-service of MIC-beds relative to the total number of maternity (M and MIC) beds in that centre, and (2) the intermediate care/all maternity care ratio represents the proportion of all women recommended to receive MIC care according to theoretical model delivering during the index period in the index centre. The intermediate care/all maternity care ratio was consistently lower than the MIC/(M+MIC) bed ratio, meaning that hospitals admit less women for intermediate care than would be expected from the MIC-bed capacity of each centre. Intermediate care patients, however, have significantly longer stays and therefore the intermediate care/all maternity care ratio has to be adjusted by weighing for length of stay, but even taking this into consideration these data seem to suggest at least to some extent an under-use of available MIC-beds. When looking at yet another ratio this became even more apparent. The intermediate care patient/MIC bed ratio describes the proportion of intermediate care women giving birth in a hospital with a MIC- centre service. This resulted in a wide range across the various MIC-centres in bed occupancy of MIC-beds by intermediate care patients, with at the lower end merely 10 women being admitted on average per MIC-bed during the one-year reference period as compared to 35 women at the higher end of the range. So basically, the proportion of women considered as requiring intermediate care relative to the hospital-specific numbers of women is not significantly different between maternities with and without MIC-services, and this proportion does not depend on maternity size. 7.5 EQUITY OF ACCESS TO CARE Several issues that explain the apparent failure of levelled maternity care in Belgium need to be addressed. It is obvious that the geographical distribution of the 17 MICservices does not parallel the Belgian population and hence delivery density. MICservices are largely clustered in the urban area of Brussels with few MIC- services dispersed in the various provinces both in the North-Western and the Southern parts of Belgium. Transfer rates from maternities without MIC service to maternities with MIC service were found to be fairly low, compared with the number of IC women. Accordingly, it could be expected that proximity of a hospital is an important determinant for admission for pregnancy-related pathology or delivery. fff Réseau de Médecine Sociale à Tournai ggg CHR-Namur has a NIC service
KCE Reports 94 Maternal Intensive Care in Belgium 95 Women requiring intermediate care travel on average longer distances to reach a hospital with a MIC-service compared to women requiring standard care. We demonstrated in a multivariable model that intermediate care classification of the women increased the likelihood of being admitted to a MIC-service with an adjusted odds ratio of 2.1 (95% CI 2.047 – 2.256). However, the mere fact of living within a distance of 30 km from a MIC-service increased the odds ratio much more: 25.8 (95% CI 20.916 – 31.799) independently of the intermediate care classification. Overall, MICadmission in Belgium seems to be primarily determined by living in the vicinity of a hospital with a MIC-service. The observation that several non-MIC services admitted larger numbers of intermediate care women than some specific MIC-services raises questions. Have those maternities developed the role of referral centre in regions distant from ‘official’ MIC-services? How are those centres dealing with the higher costs caused by providing intermediate care? How about the quality of care in these kind of referral centres functioning, de facto, as MIC-services? In our study, the global rate of prematurity (defined as
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Dépôt légal : D/2008/10.273/78
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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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