Continuity of care by a primary midwife(caseload midwifery):a cost analysis using results from the COSMOS randomised controlled trial  

作　　者：Emily J Callander Hannah Jackson Helen L McLachlan Mary-Ann Davey Della A Forster 

机构地区：[1]University of Technology Sydney,Sydney,New South Wales,Australia [2]The Royal Women's Hospital,Melbourne,Victoria,Australia [3]Faculty of Health,University of Technology Sydney,Broadway,New South Wales,Australia [4]Judith Lumley Centre,La Trobe University,Melbourne,Victoria,Australia [5]School of Nursing and Midwifery,a Trobe University,Melbourne,Victoria,Australia [6]Department of Obstetrics and Gynaecology,Monash University,Clayton,Victoria,Australia

出　　处：《Gynecology and Obstetrics Clinical Medicine》2024年第2期94-101,共8页妇产科临床医学（英文）

基　　金：the Australian National Health and Medical Research Council(Project Grant Number:433040).

摘　　要：Introduction Caseload midwifery(continuity of midwifery carer)offers benefits including lower caesarean section rates,lower risks of preterm birth and stilbirth,and improved maternal satisfaction of care.Despite these advantages,concerns about additional costs hinder widespread implementation.This study examinesthecost of caseload midwifery compared with standard maternity care from the perspective of both public hospitals and public funders.Methods A cost analysis was conducted using data from a randomised controlled trial of 2314 low-risk pregnant women in Melbourne,Australia.Women randomised to caseload care received antenatal,intrapartum and postpartum care from a primary midwife,with some care provided by a‘back-up'midwife.Women in standard care received midwifery-led care with varying levels of continuity,junior obstetric care or community-based medical care.The cost analysis compared differences in mean costs of health resources to public hospitals and to public funders.Additionally,a budget impact analysis estimated total costs to the health system between 2023 and 2027.Results For public hospitals,there was no significant difference in overall costs between women receiving caseload midwifery(n=1146)versus standard care(n=1151)($SA12363(SD:$A4967)vs$A12323(SD:$A7404);p=0.85).Conversely,public funders incurred lower expenditures for women receiving caseload midwifery($A20330(SD:$A8312))versus standard care($A21637(SD:$A11818);p<0.001).The budget impact analysis estimated savings of sA625million to the health system over the next 5 years with expanded access to caseloadmidwifery inAustralia.Conclusion Caseloadmidwifery in low-risk women is cost-neutral to public hospitals and cost-saving to public funders.Tweetable abstract Continuity of midwifery for low-risk women reduces costs to public funders,with no additional costs to hospitals.

关 键 词：RANDOM CONTINUITY CONTINUITY 

分 类 号：R473.71[医药卫生—护理学] R71[医药卫生—临床医学]