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

96 Maternal Intensive Care in Belgium KCE Reports 94
7.6.2 Limitations
An obvious limitation in our analyses is that, due to the nature of the registration
process, we were unable to discriminate between real MIC-beds and M beds, as data
registration is currently done for a maternity service as a whole. Therefore, we can only
approximate the use of MIC-beds through differences observed in admission
characteristics between hospitals with or without MIC-services.
Our findings may also have been biased to what is known as “DRG-creeping”, i.e. the
MKG coding system was designed to register clinical diagnoses to calculate disease loadbased
financing and such coding is therefore always prone to morbidity overrating.
Therefore, the apparent similarity in case mix between MIC and non-MIC services
should not only be assessed in terms of numbers of patients admitted. Indeed, it appears
as if differences actually do exist between MIC and non-MIC services in terms of types
of specific pregnancy-related morbidities.
Due to the many limitations of this study on the one hand and to a lack of a valid
registration and predefined quality indicators and evidence based guidelines in
maternities with MIC-services on the other hand, it was impossible to assess the quality
of care delivered in those maternities.
7.7 CONCLUSION
From this health services research investigation we conclude that the introduction of a
multileveled maternity care model in Belgium aimed at optimal maternity care in a costefficient
way, has insufficiently resulted in a formal levelling of maternity care and proper
use of resources as was originally intended. This is mainly due to the absence of any
formal admission criteria or referral pathways.
Of all women who are considered, according to the theoretical model, to receive
intermediate care and hence are considered to benefit from admission to a specialized
MIC-service, only 40% actually delivers in a maternity with a MIC-service. The other are
admitted to a hospital considered to act at the secondary or basic level of obstetric
care. Conversely, MIC-services seem to care at a much higher rate for women
recommended to receive standard maternity care than would be expected from their
specialized bed capacity. Despite the fact that referral pathways are not clearly defined,
with rates of intra-uterine transfer to a MIC-service being disproportionately low,
admission to a MIC-service is not only guided by medical indications but also by
geographical proximity. The proportion of IC women delivering in maternities with
MIC-services varies widely across various regions and hospitals.
In addition, the concept of intermediate care remains broad and ill defined. Neither the
literature, nor the local data make it possible to conclude that all of the ‘so-called’
intermediate care pregnancies would benefit from an admission in a MIC-service.
It is not the case with regard to the threat of premature birth (< 32 weeks). Especially
for this vulnerable group, the NIC-report emphasised that it is better to transfer the
pregnant woman to a MIC service (intra-uterine transfer), rather than to transfer the
newborn to a NIC service. Therefore, maternity units having MIC beds need to be
located at an acceptable distance. Unfortunately, in some areas, women have to cover a
long distance (over 40 km) to reach a maternity unit having MIC beds, while other
areas have a high concentration of MIC centres. This observation also raises the
question of the fair distribution of the public means including affordability and equal
access. This question of the fair distribution of means is also raised by the apparent
under usage of MIC-beds. Consequently, the distribution of MIC-beds should be reexamined
by taking into account the various indices suggested previously.