Abstract
The reduction in Caesarean sections (CSs) is widely considered a priority in the public decision makers agenda. Though the World Health Organisation has strongly encouraged countries to implement policies to reduce CSs to 10–15%, after almost thirty years this goal appears still far from its achievement. The literature depicts CS as a multifaceted phenomenon whose causes involve different factors, ranging from the patient sphere to the health care level of services provided, and the societal preference of CS practice. Policy makers aiming to standardise cares and to reduce CSs often implement maternity pathways (MP). By investigating the MP introduced in the Sicilian region, the authors highlight the need to adopt an outcome-based performance management approach to assess the effectiveness of CS reduction policies. The suggested perspective also reveals the necessity to frame and coordinate the interdependencies between the different actors playing a crucial role in the MP.
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- 1.
Examples of first-level pregnancy risk are: <16 or 40> years old woman; <150 cm height; cervical or vaginal infections; foetal malformation; three or more spontaneous abortions; epilepsy. On the other hand, examples of second-level pregnancy risk include: vaginal bleeding, uterine malformations, uterine myomas and presence of pelvic mass. There are also third-level pregnancy risks—directly treated in natal centres—such as twin pregnancy, foetal growth delays, foetal malformations and diabetes.
- 2.
In medical science, the term “outcome” has to be intended in the Donabedian’s conceptualisation, 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 analyse the post-cares 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. (2018). Designing Outcome-Based Performance Management Systems to Assess Policies Impacting on Caesarean Section Rate: An Analysis of the Sicilian Maternity Pathway. In: Borgonovi, E., Anessi-Pessina, E., Bianchi, C. (eds) Outcome-Based Performance Management in the Public Sector. System Dynamics for Performance Management, vol 2. Springer, Cham. https://doi.org/10.1007/978-3-319-57018-1_4
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