Bacci Alberta, Hodorogea Stelian, Khachatryan Henrik, Babojonova Shohida, Irsa Signe, Jansone Maira, Dondiuc Iurie, Matarazde George, Lazdane Gunta, Lazzerini Marzia
WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.
State Medical and Pharmaceutical University "N. Testemitanu", Chisinau, Moldova.
BMJ Open. 2018 Apr 12;8(4):e017696. doi: 10.1136/bmjopen-2017-017696.
The maternal near-miss case review (NMCR) cycle is a type of clinical audit aiming at improving quality of maternal healthcare by discussing near-miss cases. In several countries this approach has been introduced and supported by WHO and partners since 2004, but information on the quality of its implementation is missing. This study aimed at evaluating the quality of the NMCR implementation in selected countries within WHO European Region.
Cross-sectional study.
Twenty-three maternity units in Armenia, Georgia, Latvia, Moldova and Uzbekistan.
A predefined checklist including 50 items, according to WHO methodology. Quality in the NMCR implementation was defined by summary scores ranging from 0 (totally inappropriate) to 3 (appropriate).
Quality of the NMCR implementation was heterogeneous among different countries, and within the same country. Overall, the first part of the audit cycle (from case identification to case analysis) was fairly well performed (mean score 2.00, 95% CI 1.94 to 2.06), with the exception of the 'inclusion of users' views' (mean score 0.66, 95% CI 0.11 to 1.22), while the second part (developing recommendations, implementing them and ensuring quality) was poorly performed (mean score 0.66, 95% CI 0.11 to 1.22). Each country had at least one champion facility, where quality of the NMCR cycle was acceptable. Quality of the implementation was not associated with its duration. Gaps in implementation were of technical, organisational and attitudinal nature.
Ensuring quality in the NMCR may be difficult but achievable. The high heterogeneity in results within the same country suggests that quality of the NMCR implementation depends, to a large extent, from hospital factors, including staff's commitment, managerial support and local coordination. Efforts should be put in preventing and mitigating common barriers that hamper successful NMCR implementation.
孕产妇险些死亡病例审查（NMCR）周期是一种临床审计类型，旨在通过讨论险些死亡病例来提高孕产妇医疗保健质量。自2004年以来，世卫组织及其合作伙伴已在多个国家引入并支持了这种方法，但关于其实施质量的信息却付诸阙如。本研究旨在评估世卫组织欧洲区域选定国家中NMCR实施的质量。
横断面研究。
亚美尼亚、格鲁吉亚、拉脱维亚、摩尔多瓦和乌兹别克斯坦的23个产科单位。
根据世卫组织方法制定的包含50项内容的预定义清单。NMCR实施的质量由总结分数界定，范围从0（完全不适当）至3（适当）。
NMCR实施的质量在不同国家之间以及同一国家内部存在差异。总体而言，审计周期的第一部分（从病例识别到病例分析）执行情况相当良好（平均分数2.00，95%置信区间1.94至2.06），“纳入用户意见”部分除外（平均分数0.66，95%置信区间0.11至1.22），而第二部分（制定建议、实施建议并确保质量）执行情况较差（平均分数0.66，95%置信区间0.11至1.22）。每个国家至少有一个示范机构，其NMCR周期质量是可接受的。实施质量与其持续时间无关。实施方面的差距具有技术、组织和态度性质。
确保NMCR的质量可能困难但可实现。同一国家内结果的高度异质性表明，NMCR实施的质量在很大程度上取决于医院因素，包括工作人员的投入、管理支持和当地协调。应努力预防和减轻妨碍NMCR成功实施的常见障碍。
