中文摘要：

目的评价机构及政策干预降低非医学指征剖宫产率的效用,为后续政策制定提供依据。方法采取个案研究的方法,选择自2009年开始分娩方式综合干预的温州地区某三甲综合医院为研究对象,通过其医院信息管理系统收集2006-2014年住院分娩的29 252例产妇的病案信息,并应用χ~2检验及预测概率模型分析非医学指征剖宫产率在机构干预及相关政策作用下的变化趋势。结果 2009-2010年样本机构的非医学指征剖宫产率均值为13.49%,小于2006-2008年（15.89%）,2011-2014年在相关政策的推动下,样本机构的非医学指征剖宫产率均值进一步下降为8.81%,上述差异均有统计学意义（P〈0.001）。不同年龄组产妇在干预后,特别是在政策强化干预后（2011-2014年）发生非医学指征剖宫产的预测概率显著降低。结论样本机构的综合干预措施对非医学指征剖宫产率的控制成效明显,而政策干预通过强化机构干预作用,有利于进一步降低非医学指征剖宫产率。今后应在全国层面推广并完善机构干预措施,进一步完善考核机制,强化政策对医疗机构行为的引导作用,将我国的非医学指征剖宫产率降低至一个新的水平。

英文摘要：

Objective To evaluate the effect of institutional and policy intervention in reducing rate of cesarean section without medical indications,provide a basis for further policy-making.Methods A case study was conducted,a tertiary-level general hospital conducting comprehensive intervention of delivery modes in Wenzhou region from 2009 was selected as study object,the medical record information of29 252 women giving birth to their babies from 2006 to 2014 was collected by hospital information management system;χ~2 test and prediction probability model were used to analyze the change trend of cesarean section without medical indications after institutional and policy intervention.Results The average rate of cesarean section without medical indications in the hospital from 2009 to 2010 was 13.49%,which was lower than that from 2006 to 2008（ 15.89%）,the average rate of cesarean section without medical indications from 2011 to 2014 further decreased to 8.81% after institutional and policy intervention,there were statistically significant differences（ P〈0.001）.After intervention,the predicted probabilities of cesarean section without medical indications among the women in different age groups decreased significantly,especially from 2011 to 2014 when policy intensive intervention was conducted.Conclusion The comprehensive intervention measures achieve significant effect in controlling cesarean section without medical indications in the hospital,policy intervention through strengthening institutional intervention effect is helpful to further reduction of rate of cesarean section without medical indications.In future,institutional intervention measures should be promoted and improved in China.Further improving appraisal mechanism and strengthening the guiding function of policies can reduce the rate of cesarean section without medical indications to a new level.