高風險孕產婦健康管理試辦計畫對照護利用及結果之初步影響

Preliminary impact of a care management pilot program for high-risk pregnant women on care utilization and outcomes

"目標：為提高產前照護利用及生產結果，國際間視產前照護協調服務為重要策略。我國自2017年起，實施高風險（社會經濟及懷孕相關風險）孕婦照護協調試辦計畫，因此本研究目的為探討我國針對高風險懷孕婦女實施照護協調試辦計畫對照護利用及結果之初步影響。 方法：本研究使用國民健康署提供之資料，選取於2017年5月至2018年5月間生產之所有孕婦，並以高風險定義相關條件，透過傾向分數配對出未參加計畫者，使用多元二分類羅吉斯迴歸模型，以檢測計畫介入是否有助於改善產婦產前檢查利用至少4或8次、剖腹產、低出生體重、早產及產婦併發症。 結果：配對後共納入收案及未收案產婦各621人，參加計畫之產婦相較未參加者，產檢未達4次、低出生體重之勝算較低，勝算比分別為0.11（95%信賴區間：0.03-0.44）、0.42（95%信賴區間：0.23-0.77）。 結論：高風險孕產婦健康管理試辦計畫之初步成效，可增加高風險產婦產前照護利用至少4次，及降低低出生體重。（台灣衛誌2021；40(2)：166-175）"

Objectives: To improve prenatal care utilization and birth outcomes, prenatal care coordination for pregnant women is internationally regarded as a critical strategy. Since 2017, a care coordination pilot program for high-risk (socioeconomic- and pregnancy-related risks) pregnant women has been implemented in Taiwan. The objective of this study was to examine the preliminary impact of this program on prenatal care utilization and birth outcomes among high-risk pregnant women. Methods: Data provided by the Health Promotion Administration on all women who gave birth at any time between May 2017 and May 2018 were employed. Propensity score matching and multivariate binary logistic regression were performed to examine whether the program intervention reduced the odds of having fewer than 4 or 8 prenatal care visits, a caesarean section, a baby with low birth weight, a preterm baby, or obstetric complications. Results: Each group included 621 pregnant women after matching. Pregnant women who participated in the program had lower odds of having fewer than 4 prenatal visits or a baby with low birth weight compared with those who did not participate (odds ratio: 0.11, 95% confidence interval: 0.03-0.44; odds ratio: 0.42, 95% confidence interval: 0.23-0.77). Conclusions: The preliminary impact of the care coordination pilot program is, first, an increase in the proportion of high-risk pregnant women who undergo at least 4 prenatal care visits and, second, a decrease in the proportion of babies with low birth weight in this group. (Taiwan J Public Health. 2021; 40(2): 166-175)