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

KCE Reports 94 Maternal Intensive Care in Belgium 137
Classification of women with the indications list
The methodology used to classify the women with merged stays into the intermediate
care, ‘grey zone’ or standard care group could not be exactly reproduced with
unmerged stays.
Indeed, with unmerged stays, information about former in-patient stays, ambulatory
drugs are lacking. As explained in the methodology of the list building, to refine some
ICD-9-codes the LoS before delivery was taken into account; to refine other ICD-9 for
asthma, long term use of oral corticoids was taken into account.
The indication list with only ICD-9 codes classified 2,786 stays (60.3%) in standard care,
1,372 (29.7% in ‘grey zone’ and 464 (10.0%) in Intermediate care.
Compared to the merged stay database, the proportion of women in ‘Standard care
group’ is higher in unmerged stays (60.3% versus 55.9%) and in ‘Intermediate care’
(10.0% versus 9.6%). The difference in ‘Intermediate care’ is very slight.
The proportion of women in Grey zone is lower (29.7% versus 33.7%).
When we select only the in-patients stays for deliveries, the proportion of intermediate
care stays is 9.4% for unlinked stays versus 9.6% for linked stays.
UNMERGED STAYS OF NEWBORN BABIES
Number of stays
Between 01/10/2003 and 30/09/2004, a total of 21,646 MKG-RCM records of neonates
could not be merged with the data of their mother. This high proportion (18.0%) of
unlinked stays is explained by the structure of the data.
For most of these neonates, there is no separate bill issued. The only way to link the
stay of the newborn is through his mother. The MKG-RCM number of the mother
should be registered on the MKG-RCM record of her baby.
Nevertheless, among the non merged newborn stays, 68% do not possess the MKG-
RCM number of the mother.
In more than 97% of these unmerged stays, the IMA identification number of the
mother is missing, in 1% the IMA ID of the newborn is missing, and in 37% both ID are
missing.
Characteristics of these stays
The specific information about the location of the birth indicates that 13.9% (N= 3,004)
of the neonates with an unmerged file were transferred from another hospital and 101
(0.5%) neonates were transferred from ambulatory care, while these figures were much
lower for the merged stays (0.02% (N= 18) and 0.03% (N = 33), respectively). So, most
of the babies transfers resulted in unmerged files. The transfers and readmission in
other hospitals can not be followed up because an individual IMA/AIM ID is issued for
the baby after his transfer, hampering linkage with information of the first stay (where
maternal IMA/AIM ID was used). This also hampers computation of an accurate transfer
rate.
Table X shows the absolute figures and the differences in proportion between
characteristics of newborn babies from merged and unmerged stays.
The in-patient mortality, the proportion of multiple pregnancies, the proportion of low
birth weight babies, the proportion of premature babies, the proportion of babies
staying in NIC-services are higher among unmerged stays mmm .
The fact that the transferred newborns are included in the unmerged stays most
probably explained the difference observed between the characteristics of the newborn
from merged and unmerged in-patient stays.
mmm All differences between merged and unmerged measured by chi-square tests are statistically significant
but effect size measured by Cramer’s V or the phi coefficient were close to 0 indicating a weak
relationship between the 2 factors.