产科保健中的质量保证实践：对加利福尼亚州医院的调查。

Quality Assurance Practices in Obstetric Care: A Survey of Hospitals in California.

机构信息

Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut; the Department of Pediatrics, Division of Neonatal & Developmental Medicine, Stanford University School of Medicine, Stanford, California; the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California; and Cushing/Whitney Medical Library, Yale University, New Haven, Connecticut.

出版信息

Obstet Gynecol. 2018 Feb;131(2):214-223. doi: 10.1097/AOG.0000000000002437.

DOI:10.1097/AOG.0000000000002437

PMID:29324608

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7020098/

Abstract

OBJECTIVE

To assess hospital practices in obstetric quality management activities and identify institutional characteristics associated with utilization of evidence-supported practices.

METHODS

Data for this study came from a statewide survey of obstetric hospitals in California regarding their organization and delivery of perinatal care. We analyzed responses from 185 hospitals that completed quality assurance sections of the survey to assess their practices in a broad spectrum of quality enhancement activities. The association between institutional characteristics and adoption of evidence-supported practices (ie, those supported by prior literature or recommended by professional organizations as beneficial for improving birth outcome or patient safety) was examined using bivariate analysis and appropriate statistical tests.

RESULTS

Most hospitals regularly audited adherence to written protocols regarding critical areas of care; however, 77.7% and 16.8% reported not having written guidelines on diagnosis of labor arrest and management of abnormal fetal heart rate, respectively. Private nonprofit hospitals were more likely to have a written protocol for management of abnormal fetal heart rate (P=.002). One in 10 hospitals (9.7%) did not regularly review cases with significant morbidity or mortality, and only 69.0% regularly tracked indications for cesarean delivery. Moreover, 26.3%, 14.3%, and 8.7% of the hospitals reported never performing interprofessional simulations for eclampsia, shoulder dystocia, or postpartum hemorrhage, respectively. Teaching status was associated with more frequent simulations in these three areas (P≤.04 for all), while larger volume was associated with more frequent simulations for eclampsia (P=.04).

CONCLUSION

Hospitals in California engage in a wide range of practices to assure or improve quality of obstetric care, but substantial variation in practice exists among hospitals. There is opportunity for improvement in adoption of evidence-supported practices.

摘要

目的

评估产科质量管理活动中的医院实践，并确定与利用循证实践相关的机构特征。

方法

本研究的数据来自加利福尼亚州对产科医院进行的一项全州范围的围产期护理组织和提供情况调查。我们分析了完成调查质量保证部分的 185 家医院的回复，以评估其在广泛的质量增强活动中的实践情况。使用双变量分析和适当的统计检验，研究了机构特征与采用循证实践（即得到先前文献支持或专业组织推荐为改善分娩结果或患者安全有益的实践）之间的关联。

结果

大多数医院定期审核对关键护理领域的书面协议遵守情况；然而，分别有 77.7%和 16.8%的医院报告没有关于分娩阻滞诊断和异常胎心管理的书面指南。私立非营利性医院更有可能制定异常胎心管理的书面协议（P=.002）。每 10 家医院中就有 1 家（9.7%）没有定期审查有重大发病率或死亡率的病例，只有 69.0%的医院定期跟踪剖宫产的指征。此外，分别有 26.3%、14.3%和 8.7%的医院报告从未针对子痫、肩难产或产后出血进行过跨专业模拟。教学状态与这三个领域的模拟更频繁相关（所有 P≤.04），而更大的容量与子痫模拟更频繁相关（P=.04）。