A cost-consequences analysis of a midwifery group practice for Aboriginal mothers and infants in the top end of the Northern Territory, Australia

Yu Gao; Lisa Gold; Cath Josif; Sarah Bar-Zeev; Malinda Steenkamp; Lesley Barclay; Yuejen Zhao; Sally Tracy; Sue Kildea

doi:10.1016/j.midw.2013.04.004

A cost-consequences analysis of a midwifery group practice for Aboriginal mothers and infants in the top end of the Northern Territory, Australia

Midwifery. 2014 Apr;30(4):447-55. doi: 10.1016/j.midw.2013.04.004. Epub 2013 Jun 18.

Authors

Yu Gao¹, Lisa Gold², Cath Josif³, Sarah Bar-Zeev⁴, Malinda Steenkamp⁵, Lesley Barclay⁶, Yuejen Zhao⁷, Sally Tracy⁸, Sue Kildea⁹

Affiliations

¹ University Centre for Rural Health North Coast, School of Public Health, Sydney Medical School, University of Sydney, Lismore, NSW 2480, Australia. Electronic address: yu.gao@ucrh.edu.au.
² Deakin Population Health SRC, Faculty of Health, Deakin University, Burwood, VIC 3125, Australia. Electronic address: lisa.gold@deakin.edu.au.
³ University Centre for Rural Health North Coast, School of Public Health, Sydney Medical School, University of Sydney, Lismore, NSW 2480, Australia. Electronic address: cfar3313@uni.sydney.edu.au.
⁴ University Centre for Rural Health North Coast, School of Public Health, Sydney Medical School, University of Sydney, Lismore, NSW 2480, Australia. Electronic address: sbarzeev@mail.usyd.edu.au.
⁵ Life Course and Intergenerational Health Research Group (LIGHt), Discipline of Obstetrics and Gynaecology, Faculty of Health Sciences, The University of Adelaide, North Terrace, Adelaide SA 5005, Australia. Electronic address: malinda.steenkamp@adelaide.edu.au.
⁶ University Centre for Rural Health North Coast, School of Public Health, Sydney Medical School, University of Sydney, Lismore, NSW 2480, Australia. Electronic address: Lesley.barclay@sydney.edu.au.
⁷ Health Gains Planning, Northern Territory Department of Health, Darwin, NT 0811, Australia. Electronic address: Yuejen.zhao@nt.gov.au.
⁸ Sydney Nursing School, University of Sydney, Sydney, NSW 2006, Australia. Electronic address: stracy@ozemail.com.au.
⁹ Women's Health and Newborn Services, Australia Catholic University and Mater Mothers Hospital, Brisbane 4101, Australia. Electronic address: sue.kildea@acu.edu.au.

PMID: 23786990
DOI: 10.1016/j.midw.2013.04.004

Abstract

Objective: to compare the cost-effectiveness of two models of service delivery: Midwifery Group Practice (MGP) and baseline cohort.

Design: a retrospective and prospective cohort study.

Setting: a regional hospital in Northern Territory (NT), Australia.

Methods: baseline cohort included all Aboriginal mothers (n=412), and their infants (n=416), from two remote communities who gave birth between 2004 and 2006. The MGP cohort included all Aboriginal mothers (n=310), and their infants (n=315), from seven communities who gave birth between 2009 and 2011. The baseline cohort mothers and infant's medical records were retrospectively audited and the MGP cohort data were prospectively collected. All the direct costs, from the Department of Health (DH) perspective, occurred from the first antenatal presentation to six weeks post partum for mothers and up to 28 days post births for infants were included for analysis.

Analysis: analysis was performed with SPSS 19.0 and Stata 12.1. Independent sample of t-tests and χ2 were conducted.

Findings: women receiving MGP care had significantly more antenatal care, more ultrasounds, were more likely to be admitted to hospital antenatally, and had more postnatal care in town. The MGP cohort had significantly reduced average length of stay for infants admitted to Special Care Nursery (SCN). There was no significant difference between the two cohorts for major birth outcomes such as mode of birth, preterm birth rate and low birth weight. Costs savings (mean A$703) were found, although these were not statistically significant, for women and their infants receiving MGP care compared to the baseline cohort.

Conclusions: for remote dwelling Aboriginal women of all risk who travelled to town for birth, MGP was likely to be cost effective, and women received better care and resulting in equivalent birth outcomes compared with the baseline maternity care.

Keywords: Australia; Cost-consequences analysis; Indigenous; Midwifery Group Practice.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cohort Studies
Costs and Cost Analysis
Female
Humans
Infant, Newborn
Maternal-Child Health Services / economics*
Midwifery / economics*
Midwifery / methods
Native Hawaiian or Other Pacific Islander / statistics & numerical data
Northern Territory / epidemiology
Nurse's Role*
Practice Patterns, Nurses' / economics*
Prospective Studies
Rural Health Services / economics*
Young Adult