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

KCE Reports 94 Maternal Intensive Care in Belgium 13
• Equity
o What is the epidemiology of obstetrical problems and risks in
Belgium?
o What is the need of intensive maternity care?
o Does the offer of care address these needs?
o How many MIC-beds do exist in Belgium?
o How are they attributed to hospitals: coincidentally, according
to geographical criteria, according to the pathology treated by
the hospital or other criteria?
o What are the criteria of distribution to the country?
o Do all the women with high-risk pregnancy or obstetrical
problem have equal access to high quality care in MIC-services?
Is there any barrier of access to care?
A descriptive statistics analysis was performed including:
- at the maternity level: number of maternities; types (With MIC-beds, with isolated
NIC-beds and others); geographical situation; number of maternity beds, number of
MIC-beds and proportion of MIC-beds per maternity.
- at the mother level: age, socioeconomic characteristics, place of residence, mode of
delivery, length of stay (and number of in-patients stays), frequency of ICD-9-CM codes
(primary and secondary) during hospitalization, transfers, mortality.
- at the newborn level: status (stillborn or alive), in-hospital mortality, birth weight,
gestational age, Apgar score, stay in a NIC or N* department.
Secondly, the differences between maternities with MIC- and without MIC-services in
terms of mother and newborn characteristics were analyzed. Student t-test and chi
square test were used to assess differences in distributions of continuous and
categorical variables, respectively. To assess the link between MIC-beds supply and
utilization, the proportion of "intermediate care" women who delivered in maternities
with MIC-services with the proportion of MIC-beds were compared and stratified by
province and hospital.
2.3 CONSTRUCTION OF THE THEORETICAL MODEL OF
INDICATIONS FOR MIC-ADMISSION
Whereas delineating obstetrical pathology is a challenging exercise by itself, it proved
even more difficult to translate distinct pathologies into sufficiently specific ICD-9 codes.
An extensive search for guidelines and evidence concerning obstetric intermediate care
showed low accuracy of classifications of obstetrical pathology in relation to MIC.
Therefore we decided to develop a theoretical frame of indication for maternal
intermediate care admission based on a clinically designed list.
2.4 APPLYING THE THEORETICAL MODEL TO THE DATA
An algorithm based on the theoretical model was applied on the data and a bivariate
analysis was conducted. Multivariate analysis was performed by logistic regression. The
dependent variable was "admission in MIC-service" and the independent zones are: the
categories of care (intermediate care, standard and grey zone), the mode of delivery,
the age in 5 years category, the socioeconomic status and the median distance in
kilometres to reach a maternity with MIC-service.
2.5 DISCUSSION AND CONCLUSION
Finally, the literature findings and the results of data-analysis were discussed in order to
answer the research questions and to formulate conclusions.