Technology Assessment Of Collective Intervention Model For Maternal Health Care In Community

1. Study Objects and SignificancesSince the importance of maternal health care in the whole pregnant period is remarkable, it plays a crucial role to ensure the safety of maternal and infant. The security of maternal and infant is the symbol for social development level. Maternal health care is the effective method to reduce the maternal and infant death and birth defects. In the past,"maternal and infant safety" is the first and even only focus during the delivery process. However, with the higher standard of living and health care consciousness,"security" has not been the only requirements for maternal and their families. At present by the medical center for health care model has not be able to meet current demand. The study based on the construction of collective intervention model for maternal health care in community, which had been researched. This was a procession contained four parts of appropriate technologies, which included basic health care, health education, high-risk pregnancy and postpartum depression aspects. All the four parts operated by "maternal health care collective intervention platform". The platform made the community doctors, maternal and their families, leader of community, society going interaction and cooperation. Then, formed "maternal health care collective intervention plan", it would be used by community’s worker concretely. For maternal individual, the model covered their "pre-pregnancy-prenatal-Production Time-postpartum" whole period; for technology, the model included specific content, time, frequency, location, collective aspects of physical-psychology-society; for administration, the model had prominent purpose, through the management means to ensure operation and the realization of the technical value. After intervention carry out in the sample communities, the effect needs to assessment. This research use health technology assessment method to assess safety, effectiveness, economic, and social effect of model. The study aims to improve the intervention plan, provide reference and policy advice.2. Research methods and Data SourcesThrough health assessment technology, we assessed the safety, effectiveness, economic, and social effect of model; as a theoretical basis, evidence medicine collected the evaluation data; project management and business process management suggest the ideas developing and evaluating intervention programs; based on the project evaluation, we determined evaluation of the intervention program ideas; implementation of intervention process and evaluation processes follow overall quality management thoughts; Use the standard cost accounting method to finish economic assessment of the model.The main source and collection methods including:construction of intervention model and development of intervention plan; through the baseline survey, the investigation, the final survey, and the retrospective investigation method to complete cost survey, supplied with the data sources of the evaluation on the implementation effect for intervention model; through supervision interviews during intervention process and case study at the end of intervention, completed qualitative material collection for evaluation of the model.Data is entered in Excel, Epidata, analysis is completed in SPSS15.0. In addition to a general description of all related data, but also linear regression analysis between maternal and their husband, assess maternal mood varies with their husband.3. Main study results(1) Safety assessment for the modelOnly premise in security, it has sense to talk about effectiveness, economy and society. This part completed safety assessment through the people who use the technology, technology, and the process of technology use. As the people, refers to doctors, maternal and administrators, the assessment have been done according with safety prediction of the basic conditions before intervention, problem solution which faced during the intervention, safety review after the intervention. As the technology, assessment going through the development of appropriate technology procession and users’evaluation to technology. As the process of technology use, demonstrate with dynamic way. Through the qualitative and quantitative results show that the model has higher levels of security compared with the traditional way, it met the new higher demand for safety.(2) Effectiveness assessment for the modelIn the effectiveness assessment, the effect after maternal use appropriate technology was mainly focused. The result showed, since awareness rate of health care knowledge was59.5%, after the intervention by up to82.4%; attitude cognitive rate improved from80.0%to86.8%; behavioral cognitive rate improved from52.4%to67.7%. In the physical aspects, the awareness rate on pre-pregnancy and prenatal health care knowledge has significantly improved, but rate of postpartum was relative low, so risk factors on postpartum occurred rise in trend. In psychological, postpartum loss appeared, but the rate of active see doctor was not improved. For mental problems, the traditional consciousness still have a limited role. The purpose of intervention is detecting self-problems and diagnosis and treatment at earlier time, by the way of study, intercommunication and self-screen in the model. From the psychological scale score result showed in the whole process of pregnancy, the total score which representative dangerous situation was falling, following intervention going on; On the social side, maternal confirmed the effect for participated in intervention, but them tend to ignore the affect from people around. Since the physiological-psychological-social three aspects of health care are not independent of each other, they interacted and related with each other.(3) Economic assessment for the modelUse the method of standard cost accounting to account the cost of model. The aim was accounting the new added-workload cost, beyond the current situation. To the intervention community in the east of a developed area, the cost in the standard conditions to hold once was1015.92Yuan, higher than the actual cost185.2Yuan, human cost was the main part of the higher. Each pregnant woman spend101.60Yuan, according to the standard of10people participate in intervention once. Due to different communities have different baseline level of configuration and human resources, community institutions had been divided into four categories for analysis. It had been found that, the human cost is the major influence imminent in the total, the cost accounted for71.35%. The unit cost would be different if the scale of mode changed. In order to guarantee the quality of intervention, also considering the cost fee, the ideal number of the pregnant women is15-20each intervention. If the number of each intervention is more than30people, in order to guarantee the quality of the intervention, it should increase another intervention at the same time.(4) Social assessment for the modelThe people around the maternal, her husband, parents, relatives, friends and colleagues, doctors, community street workers, the media are likely to affect maternal in physical and psychological situation. One is not exist independently in society. It should be considered the other group around maternal, who would influence maternal in the social environment. Analysised the attitude and participant rate of husband, community doctors and the leaders. It found that, husband in the anxiety and depression mood during pregnancy would affect his wife’s mood. After the intervention, from the evaluation of wives to the husbands’performance showed husbands had reduced their risk behaviors. In the evaluation of husbands, they found the content was a little bit boring for them. Community doctors said their service style and capability have been improved obviously through intervention. Community administrator reflected the obstructive factors and gave easy-for-copy advice. At the late time of intervention, conducted case study to dig the deep reason of the problems and propose solution. The aim is work out the more perfect intervention plans and provide the reference for the next stage.4. Study conclusionsThe study used the method of health technology assessment, demonstrated the safety, efficacy, economic, and social effect of the maternal care collective intervention model’s implementation qualitatively and quantitatively. The result showed that the model have a high safety. Through the use of the technology, it had been improved that pregnant women’s capability of self-management and health literacy had improved; for community institutions doctors, improved their ability of service and the skill, gave them more confidence at work. The model provided a communication platform for the pregnant, doctors, leaders and social. The value of the model gained praise. Through the intervention, it had been proved that the intervention communities would accept the added-workload. Even so, still need support from government. This model has a great social significance and implementation value.