Using epidemiological and health economic measures to inform maternity staffing decisions: A guide |
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| Institution: | 1. School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia;2. Judith Lumley Centre, La Trobe University, Melbourne, Australia;3. Royal Women’s Hospital, Melbourne, Australia;1. Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia;2. Westmead Institute for Maternal and Fetal Medicine, Women’s and Newborn Health, Westmead Hospital, New South Wales, Australia;3. Women’s and Newborn Health, Westmead Hospital, New South Wales, Australia;4. Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia;5. Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia;6. Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia;7. Department of Diabetes & Endocrinology, Westmead Hospital, Sydney, Australia;8. Charles Perkins Centre, The University of Sydney, New South Wales, Australia;1. Department of Anesthesiology, Columbia University Medical Center, Columbia University, 630 West 168th Street PH-5, New York, NY 10032, USA;2. Department of Anesthesiology, Sidra Medicine, Al Gharrafa Street, Ar-Rayyan, Doha, Qatar;1. University of Wollongong, Australia;2. School of Nursing, University of Wollongong, Australia;1. Hospices Civils de Lyon, Département de gynécologie obstétrique, Hôpital Femme Mère Enfant, Centre Hospitalo-Universitaire, 59, boulevard Pinel, 69500 Bron, France;2. Université de Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, 69008 Lyon, France;3. Hospices Civils de Lyon, Département de néonatalogie, Hôpital Femme Mère Enfant, Centre Hospitalo-Universitaire, 59, boulevard Pinel, 69500 Bron, France;4. Centre International de Recherche en Infectiologie, Inserm U1111, CNRS UMR5308, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France;5. Université de Lyon, Université Claude Bernard Lyon 1, EA 4129, Lyon, France;1. School of Medicine, Western Sydney University, Australia;2. South Western Sydney Local Health District, Australia;3. School of Nursing and Midwifery, Western Sydney University, Australia |
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| Abstract: | BackgroundThere is growing concern around unnecessary intervention (particularly caesarean section) at birth in high-income countries. Caseload midwifery care aims to offset this, but is perceived to be costly to health services.AimTo use epidemiological and health economic techniques to estimate health outcomes and cost-savings of different levels of equivalent full time (EFT) midwives working in caseload midwifery care.MethodsTwo simulations were conducted — one assuming 10 EFT midwives working in a caseload model, with 35 women per caseload, and one assuming 50 EFT midwives working in a caseload model, with 45 women per caseload. Both were based on a sample of 5000 women. The main model inputs included rates of health outcomes for women (caesarean section, epidural anaesthesia, and episiotomy) and infants (low birthweight and admissions to special care nursery (SCN) or neonatal intensive care unit (NICU)), and the cost savings associated with health outcome avoidance.FindingsThe first simulation estimated 27 fewer caesarean sections, 12 fewer epidurals, 12 fewer episiotomies, 10 fewer low birthweight births, and 23 fewer infants admitted to SCN or NICU annually, at a total cost saving of AU$1,874,715. The second simulation estimated 173 fewer caesarean sections, 76 fewer epidurals, 76 fewer episiotomies, 65 fewer low birthweight births, and 150 fewer infants admitted to SCN or NICU annually, at a total cost saving of AU$12,051,741.ConclusionThis study provides local-level decision-makers with a decision-tool to calculate the potentially avoidable health outcomes and cost savings associated with implementing caseload midwifery care in their own service. |
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| Keywords: | Value-based purchasing Maternal health services Health care costs Decision support techniques Midwifery |
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