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Biomedical subjects

M Mugford

Publications and source records attributed to M Mugford.

12 recordsLinked to original sources
PubMed1991

Effects of feedback of information on clinical practice: a review.

OBJECTIVE: To establish what is known about the role of feedback of statistical information in changing clinical practice. DESIGN: Review of 36 studies of interventions entailing the use of statistical information for audit or practice review, which used a formal research design. SUBJECTS: Papers identified from computer searches of medical and health service management publications, of which 36 describing studies of interventions designed to influence clinical care and including information feedback from clinical or administrative data systems were reviewed. MAIN OUTCOME MEASURES: Evidence for effect of information feedback on change in clinical practice. RESULTS: Information feedback was most likely to influence clinical practice if it was part of strategy to target decision makers who had already agreed to review their practice. A more direct effect was discernable if the information was presented close to the time of decision making. The questions of the optimum layout and quantity of information were not addressed; the 36 papers were insufficient for defining good formats for information to be used for audit or quality assurance. CONCLUSIONS: Given the cost of information processing and the current emphasis on closing the audit loop in the health services, it is important that the use of information in the audit process should be critically evaluated.

Clinical Medicine↗
PubMed1991

How does the mode of delivery affect the cost of maternity care?

In this paper we present estimates of the difference in the cost of hospital care for women having different modes of singleton delivery. The estimates are based on observation of resources used in different procedures, and on data from the North West Thames Region Maternity Information System. For vaginal delivery the average cost is 363 pounds, but could fall between 189 pounds and 773 pounds, and for caesarean section the average cost is 1123 pounds, with a likely range from 837 pounds to 1560 pounds. The wide ranges in the costs of the two modes of delivery reflect variation in the length of stay and in the intensity of care required. The average cost for intrapartum care and postnatal stay is estimated to be 451 pounds for all singleton births. Variation in operative delivery rates between hospitals implies differences in the overall cost of care at different maternity units. This partly reflects differences in the needs of the population served by the units, but also differences in clinical practice. It is important for decision makers to consider the balance between the costs and outcomes of different policies of care.

Cesarean Section↗
PubMed1991

Cost implications of different approaches to the prevention of respiratory distress syndrome.

Because the incidence of both neonatal respiratory distress syndrome and neonatal mortality can be reduced by giving corticosteroids to women expected to deliver preterm and by giving surfactant to babies at high risk of developing hyaline membrane disease, we have considered what effects the adoption of one or both of these preventive policies would have on the costs of neonatal care. We have estimated the effects of treatment from overviews of the relevant controlled trials, and estimated costs from observations of care at one neonatal unit. Our results suggest that if either of these policies is adopted for all babies under 35 weeks' gestation at a drug cost of 150 pounds or less/baby, the overall costs of care would be reduced by between 1 and 10%. The cost per survivor would be reduced by up to 16% even if the drug cost were to be as high as pounds 550/baby. If the policies were to be adopted only for babies under 31 weeks' gestation, both policies would result in a reduction in cost of between 5 and 16%/survivor, although the increased survival resulting from the policies would lead to an increase in overall costs for babies of less then 31 weeks' gestation of between 7 and 32%.

Adrenal Cortex Hormones↗
PubMed1989

Reducing the incidence of infection after caesarean section: implications of prophylaxis with antibiotics for hospital resources.

OBJECTIVES: To estimate the cost effectiveness of giving prophylactic antibiotics routinely to reduce the incidence of wound infection after caesarean section. DESIGN: Estimation of cost effectiveness was based, firstly, on a retrospective overview of 58 controlled trials and, secondly, on evidence about costs derived from data and observations of practice. SETTING: Trials included in the overview were from obstetric units in several different countries, including the United Kingdom. The costing study was based on data referring to the John Radcliffe Maternity Hospital, Oxford. SUBJECTS: A total of 7777 women were included in the 58 controlled trials comparing the effects of giving routine prophylactic antibiotics at caesarean section with either treatment with a placebo or no treatment. Cost estimates were based on data on 486 women who had caesarean sections between January and September 1987. MAIN OUTCOME MEASURE: Cost effectiveness of prophylaxis with antibiotics. RESULTS: The odds of wound infection are likely to be reduced by between about 50 and 70% by giving antibiotics routinely at caesarean section. Forty one (8.4%) women who had caesarean section were coded by the Oxford obstetric data system as having developed wound infection. The additional average cost of hospital postnatal care for women with wound infection (compared with women who had had caesarean section and no wound infection) was estimated to be 716 pounds; introducing routine prophylaxis with antibiotics would reduce average costs of postnatal care by between 1300 pounds and 3900/100 pounds caesarean sections (at 1988 prices), depending on the cost of the antibiotic used and its effectiveness. CONCLUSIONS: The results suggest that giving antibiotics routinely at caesarean section will not only reduce rates of infection after caesarean section but also reduce costs.

Ampicillin↗
PubMed1988

Factors affecting the outcome of maternity care. 1. Relationship between staffing and perinatal deaths at the hospital of birth.

This is the first of two papers describing a retrospective study of maternity hospitals in an English health region using data for the years 1977-83. The research was designed to investigate the relationship between resources (such as staff and equipment) and the outcomes of births at maternity units. Considerable variation in medical and nursing staffing levels in the units in the study was observed. Regression analysis suggests that, after taking account of differences in very low weight births at each unit, the level of paediatric staffing at a maternity unit is a significant factor in explaining differences in "in house" mortality. There was no identifiable relationship between staff categories other than paediatricians and the rate of perinatal death at the hospital of delivery. As selective referral and transfers between hospitals may affect the interpretation of these findings, a second paper follows presenting the results of a further analysis that adjusts both resources and outcomes to take account of neonatal transfers.

Birth Weight↗
PubMed1988

Factors affecting the outcome of maternity care. II. Neonatal outcomes and resources beyond the hospital of birth.

Analysis of data about perinatal mortality and indicators of resources at maternity hospitals in the West Midlands region between 1977 and 1983 showed that paediatric staff ratios were inversely related to in-house mortality rates. In this paper, the outcomes for and resources used by transferred babies are added to those of the hospital of birth for three of the study years--1978, 1980, and 1982. Patterns of transfer differ between units and over time in the region, and a regional neonatal intensive care policy was introduced in 1980. Analysis of the new variables showed that in 1978 paediatric staffing was significantly inversely related to neonatal mortality. In later years, neonatal mortality of births at maternity units is explained entirely by the proportion of low or very low weight births.

England↗
PubMed1987

Information for managers in hospitals: representing maternity unit statistics graphically.

Staff who organise and run maternity units contribute many statistics to their health authority but do not find it easy to obtain information about their unit from these statistics. Data that are collected routinely, however, can be used to provide each unit with a graphical profile of its activity and resources. The method described here was derived from the personality profiles used by psychologists and allows staff in one unit to assess the outcome, activity, and use of resources in their unit in relation to similar units, to explain some of the differences when these occur, or to highlight potential problems. Examples are taken from a study of maternity units in the West Midlands. It is concluded that the technique can indicate potential problems and usefully be adopted by those who monitor maternity care in districts or hospitals.

Data Collection↗