Department of Health Informatics in the School of Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
School of Nursing, Faculty of Health Sciences, Morinomiya University of Medical Sciences, 1-26-16 Nankokita, Suminoe-ku, Osaka, 559-8611, Japan.
BMC Pregnancy Childbirth. 2017 Sep 22;17(1):315. doi: 10.1186/s12884-017-1468-4.
In childbirth, most deliveries are low-risk, defined as spontaneous labor at full term without special high-risk facts or complications, especially in high-resource countries where maternal and perinatal mortality rates are very low. Indeed, the majority of mothers and infants have no serious conditions during labor. However, the quality of care provided is not assured, and performance may vary by birthing facility and provider. The overuse of technology in childbirth in some parts of the world is almost certainly based on assumptions like, "something can go wrong at any minute." There is a need to assess the quality of care provided for mothers and infants in low-risk labor. We aimed to develop specific quality indicators for low-risk labor care provided primarily by midwives in Japan.
We used a RAND-modified Delphi method, which integrates evidence review with expert consensus development. The procedure comprises five steps: (1) literature review, including clinical practice guidelines, to extract and develop quality indicator candidates; (2) formation of a multidisciplinary panel; (3) independent panel ratings (Round 1); (4) panel meeting and independent panel ratings (Round 2); and (5) independent panel ratings (Round 3). The three independent panel ratings (Rounds 1-3) were held between July and December 2012.
The assembled multidisciplinary panel comprised eight clinicians (two pediatricians, three obstetricians, and three midwives) and three mothers who were nonclinicians. Evidentiary review extracted 166 key recommendations from 32 clinical practice guidelines, and 31 existing quality indicators were added. After excluding duplicate recommendations and quality indicators, the panel discussed 25 candidate indicators. Of these, 18 were adopted, one was modified, six were not adopted, and four were added during the meeting, respectively.
We established 23 quality indicators for low-risk labor care provided by midwives in labor units in Japan.
在分娩中，大多数分娩是低风险的，定义为足月时自发性分娩，没有特殊的高风险因素或并发症，尤其是在高资源国家，那里的孕产妇和围产期死亡率非常低。事实上，大多数母亲和婴儿在分娩过程中没有严重的情况。然而，所提供的护理质量并不能得到保证，而且表现可能因分娩机构和提供者而异。在世界上的一些地区，在分娩中过度使用技术几乎可以肯定是基于这样的假设，即“任何时候都可能出问题”。有必要评估低风险分娩中为母亲和婴儿提供的护理质量。我们的目标是为日本主要由助产士提供的低风险分娩护理制定具体的质量指标。
我们使用了 RAND 改良德尔菲法，该方法将证据审查与专家共识制定相结合。该程序包括五个步骤：（1）文献综述，包括临床实践指南，以提取和制定质量指标候选者；（2）组建多学科小组；（3）独立小组评分（第一轮）；（4）小组会议和独立小组评分（第二轮）；（5）独立小组评分（第三轮）。这三轮独立小组评分（第 1-3 轮）于 2012 年 7 月至 12 月举行。
组成的多学科小组包括 8 名临床医生（2 名儿科医生、3 名产科医生和 3 名助产士）和 3 名非临床医生的母亲。证据审查从 32 项临床实践指南中提取了 166 项关键建议，并增加了 31 项现有质量指标。排除重复建议和质量指标后，小组讨论了 25 个候选指标。其中，18 个被采纳，1 个被修改，6 个未被采纳，在会议期间分别增加了 4 个。
我们为日本分娩单位的助产士提供的低风险分娩护理制定了 23 项质量指标。
