Filippi Veronique, Brugha Ruairi, Browne Edmund, Gohou Valerie, Bacci Alberta, De Brouwere Vincent, Sahel Amina, Goufodji Sourou, Alihonou Eusebe, Ronsmans Carine
Maternal Health Programme, Health Policy Unit, London School of Hygiene and Tropical Medicine, London, UK.
Health Policy Plan. 2004 Jan;19(1):57-66. doi: 10.1093/heapol/czh007.
This paper outlines the practical steps involved in setting up and running multi-professional, in-depth case reviews of 'near miss' obstetrical complications. It draws on lessons learned in 12 referral hospitals in Benin, Côte d'Ivoire, Ghana and Morocco. A range of feasibility indicators are presented which measured the implementation and frequency of audit activities, the quality of participation, adherence to the planned protocol for the near-miss audits, the quality of audit discussions and the sustainability of the project. Although the principles of the audit approach were well accepted and implemented everywhere, near-miss audits appeared most successful in first referral level hospitals. Contextual factors that determine the successful implementation of near-miss audit include staff finding adequate time for audit activities, financial incentives to groups rather than individuals, involvement of senior staff and hospital managers, the ease of communication in smaller units, the employment of social workers for the incorporation of women's views at audits, and the strength of external support provided by the research team. The poor quality of information recorded in case notes was recognized everywhere as a deficiency, but did not present a major obstacle to effective case reviews. Ownership and leadership within the hospital, more easily achieved in the first-level referral hospitals, were probably the most important determinants of successful implementation. Sustainability requires a commitment to audit from policy makers and managers at higher levels of the health system and some devolution of resources for implementing recommendations.
本文概述了开展和实施针对产科“险些发生”并发症的多专业深入病例审查所涉及的实际步骤。它借鉴了在贝宁、科特迪瓦、加纳和摩洛哥的12家转诊医院所吸取的经验教训。文中列出了一系列可行性指标，这些指标衡量了审计活动的实施情况和频率、参与质量、对险些发生事件审计计划方案的遵守情况、审计讨论的质量以及项目的可持续性。尽管审计方法的原则在各地都得到了很好的接受和实施，但险些发生事件审计在一级转诊医院似乎最为成功。决定险些发生事件审计成功实施的背景因素包括：工作人员为审计活动找到充足时间、对团队而非个人的经济激励、高级工作人员和医院管理人员的参与、较小单位内沟通的便利性、聘请社会工作者以便在审计中纳入妇女的意见，以及研究团队提供的外部支持力度。病例记录中所记录信息质量差在各地都被视为一项不足之处，但并非有效病例审查的主要障碍。医院内部的自主权和领导力在一级转诊医院更容易实现，这可能是成功实施的最重要决定因素。可持续性要求卫生系统高层的政策制定者和管理人员致力于审计工作，并下放一些资源用于实施各项建议。
