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

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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.
KCE Reports 94 Maternal Intensive Care in Belgium 97 8 APPENDICES APPENDIX CHAPTER 3 ANNEX 1: KEYWORDS LITERATURE REVIEW MIC-DEFINITIONS, PUBMED-SEARCH Date 27/03/07 Database (name + access ; eg Medline OVID) Search Strategy (attention, for PubMed, check « Details ») Pubmed (limits: 1997-2007, human) Central library Ghent, www.pubmed.gov Database: Ovid MEDLINE(R) Search Strategy: ----------------------------------------------------------- 1 Subacute Care/ (612) 2 Subacute unit?.mp. (31) 3 Subacute intensive care.mp. (2) 4 Hospital Units/ (6959) 5 Intermediate care.tw. (692) 6 Intermediate care unit?.mp. (167) 7 Intermediate care bed?.mp. (15) 8 Intermediate care team?.mp. (4) 9 Post acute care.mp. (133) 10 Critical Care/ (18237) 11 "Sub intensive care".mp. (3) 12 Progressive Patient Care/ (1085) 13 Progressive Patient Care / (14392) 14 Postnatal Care/ (2534) 15 Perinatal Care/ (1307) 16 Obstetrical Nursing/ (2380) 17 Neonatalogy/ (0) 18 Pregnancy/ (552736) 19 Postpartum Period/ (12628) 20 Maternal Mortality/ (5698) 21 exp Pregnancy Complications/ (253793) 22 Infant, Newborn/ (388794) 23 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 (854359) 24 13 or 14 or 16 or 18 or 19 or 20 or 21 (580177) 25 1 or 2 or 3 or 6 or 7 or 8 or 9 or 10 or 11 or 12 (20157) 26 4 and 5 (34) 27 25 or 26 (20164) 28 24 and 27 (418) 29 limit 28 to ("review articles" and yr="2000 - 2007") (46) 30 limit 28 to "review articles" (93) 31 limit 28 to yr="2000 - 2007" (78) 32 30 or 31 (125) 33 from 32 keep 1-125 (125)
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35. Etude relative aux coûts poten
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