Profile analysis is one of the main strategies recommended by the Professional Standards Review Organizations for the evaluation of health services. It is a presentation of aggregated data, relative both to process and to outcome, in a format which displays patterns of use of health services over a defined period of time. As it often utilizes routinely collected data, it represents a simple and economical tool for the continuous monitoring and evaluation of medical services. Its main advantage is the early identification of problem areas where to address more specific audit interventions. The purpose of the present paper is to give an example of the application of profile analysis to the evaluation of the Perinatal Service of Trieste. Most of the data that are used have been collected within the Collaborative Multicentric Study of Perinatal Preventive Medicine (MPP1) supported by the Italian Research Council; some others, on neonatal mortality and morbidity, come from the routine collection of data in our service. The process variables we have chosen are: use of cardiotocography and amnioscopy, number of cesarean sections for all indications and for fetal distress, number of operative vaginal deliveries, percentage of alcalinization and umbilical vein catheterization in newborns presenting with an Apgar score of 4 or less at the first minute, number of determinations of hemoglobin and blood glucose after birth. The outcome variables are: perinatal mortality, total and corrected (excluding deaths due to congenital malformations) neonatal mortality, birth weight specific neonatal mortality, prematurity, low birth weight, birth asphyxia, hyaline membrane disease and 'neonatal diseases' in general. The outcome data show a good level of neonatal health in our service: the number of at-risk patients, the incidence of neonatal disorders, total and birth weight specific neonatal mortality have decreased over the years to values that are comparable with the best figures reported in the literature. The process data show an extensive use of technology, like cardiotocography, in the management of labor and delivery. The frequency of cesarean sections has increased, with a corresponding reduction of the number of operative vaginal deliveries. The pediatric staff applies invasive therapeutical procedures in the delivery room less and less frequently. On the other hand, the number of simple diagnostic tests, like hemoglobin and blood glucose determinations, is rising, without a corresponding increase in the incidence of anemia and hypoglicemia. This may represent a form of hyperutilization of ready available procedures. In conclusion, the application of profile analysis to the Perinatal Service of Trieste demonstates the advantages of this strategy for the evaluation of both outcomes and staff attitudes. Profile monitoring does not allow, in general, to establish causal relationships between patterns of care and outcomes, or to draw definite conclusions on the quality of care: it must be considered a simple and powerful preliminary step to more specific studies.
|Translated title of the contribution||The use of profile analysis in the evaluation of neonatal care|
|Number of pages||9|
|Journal||Rivista Italiana di Pediatria|
|Publication status||Published - 1985|
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health