Abstract
The World Health Organization since the last three decades strongly encourages countries to reduce the caesarean section (CS) rate down to 10–15%. However, this goal nowadays appears still far from its achievement. Public decision-makers are indeed struggling to design and implement effective policies to reduce the CS rate. The literature provides a wide range of factors causing a change in the CS rate, such as the patient clinical profile and the healthcare service quality provided. Maternity pathway (MP) is considered a mean through which to standardize the cares and to reduce CSs. This study investigates the MP recently introduced in Sicilian local health authorities. Based on such an analysis, an outcome-based performance management approach has been used by the authors to build a system dynamics model. Scenario simulation results reveal that such an approach may support decision-makers to learn how to design CS reduction policies. It particularly remarks the necessity to implement policies oriented to coordinate the actions undertaken by the different actors playing a crucial role in the MP.
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Notes
- 1.
Examples of first-level pregnancy risk are <16 or >40-year-old woman, <150 cm height, cervical or vaginal infections, fetal malformation, three or more spontaneous abortions, epilepsy, etc. On the other hand, examples of second-level pregnancy risk include: vaginal bleeding, uterine malformations, uterine myomas, and the presence of pelvic mass. There are also third-level pregnancy risks—directly treated in natal centers—such as twin pregnancy, fetal growth delays, fetal malformations, diabetes, etc.
- 2.
In medical science, the term “outcome” has to be intended in the Donabedian’s conceptualization, i.e., it refers to a patient’s health status or change in health status resulting from the medical care received (Donabedian 2005). This definition is oriented to analyze the post-care patient survival conditions and includes intended outcomes (e.g., the relief of pain), as well as unintended outcomes (e.g., complications).
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Bivona, E., Cosenz, F. (2017). Framing Caesarean Section Reduction Policies Through a Dynamic Performance Management Approach: A Maternity Pathway Case-Based Analysis. In: Qudrat-Ullah, H., Tsasis, P. (eds) Innovative Healthcare Systems for the 21st Century. Understanding Complex Systems. Springer, Cham. https://doi.org/10.1007/978-3-319-55774-8_8
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