坦桑尼亚达累斯萨拉姆医院孕产妇和围产儿审计系统变化的因素。
Factors for change in maternal and perinatal audit systems in Dar es Salaam hospitals, Tanzania.
机构信息
Tanzanian Training Centre for International Health, Ifakara, Tanzania.
出版信息
BMC Pregnancy Childbirth. 2010 Jun 3;10:29. doi: 10.1186/1471-2393-10-29.
BACKGROUND
Effective maternal and perinatal audits are associated with improved quality of care and reduction of severe adverse outcome. Although audits at the level of care were formally introduced in Tanzania around 25 years ago, little information is available about their existence, performance, and practical barriers to their implementation. This study assessed the structure, process and impacts of maternal and perinatal death audit systems in clinical practice and presents a detailed account on how they could be improved.
METHODS
A cross sectional descriptive study was conducted in eight major hospitals in Dar es Salaam in January 2009. An in-depth interview guide was used for 29 health managers and members of the audit committees to investigate the existence, structure, process and outcome of such audits in clinical practice. A semi-structured questionnaire was used to interview 30 health care providers in the maternity wards to assess their awareness, attitude and practice towards audit systems. The 2007 institutional pregnancy outcome records were reviewed.
RESULTS
Overall hospital based maternal mortality ratio was 218/100,000 live births (range: 0 - 385) and perinatal mortality rate was 44/1000 births (range: 17 - 147). Maternal and perinatal audit systems existed only in 4 and 3 hospitals respectively, and key decision makers did not take part in audit committees. Sixty percent of care providers were not aware of even a single action which had ever been implemented in their hospitals because of audit recommendations. There were neither records of the key decision points, action plan, nor regular analysis of the audit reports in any of the facilities where such audit systems existed.
CONCLUSIONS
Maternal and perinatal audit systems in these institutions are poorly established in structure and process; and are less effective to improve the quality of care. Fundamental changes are urgently needed for successful audit systems in these institutions.
背景
有效的孕产妇和围产儿审计与提高护理质量和减少严重不良结局有关。尽管坦桑尼亚大约 25 年前就正式引入了护理水平的审计，但关于其存在、绩效以及实施的实际障碍的信息很少。本研究评估了临床实践中孕产妇和围产儿死亡审计系统的结构、过程和影响，并详细介绍了如何改进这些系统。
方法
2009 年 1 月，在达累斯萨拉姆的八所主要医院进行了一项横断面描述性研究。使用深入访谈指南对 29 名卫生管理人员和审计委员会成员进行了调查，以了解这些审计在临床实践中的存在、结构、过程和结果。使用半结构式问卷对产房的 30 名卫生保健提供者进行了访谈，以评估他们对审计系统的认识、态度和实践。审查了 2007 年的机构妊娠结局记录。
结果
总体而言，医院基础孕产妇死亡率为 218/100,000 活产（范围：0-385），围产儿死亡率为 44/1000 出生（范围：17-147）。只有 4 家和 3 家医院分别存在孕产妇和围产儿审计系统，关键决策者并未参与审计委员会。由于审计建议，60%的护理提供者甚至不知道他们医院实施过的单一行动。在存在这些审计系统的任何设施中，都没有关键决策点、行动计划的记录，也没有对审计报告进行定期分析。
结论
这些机构的孕产妇和围产儿审计系统在结构和过程方面都建立得很差，对提高护理质量的效果也不大。这些机构迫切需要进行根本性的变革，以建立成功的审计系统。
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