一套用于评估世界卫生组织安全分娩检查表实施情况及效果的指标的构建与预试验

Construction and pilot test of a set of indicators to assess the implementation and effectiveness of the who safe childbirth checklist.

作者信息

Saturno-Hernández Pedro J, Fernández-Elorriaga María, Martínez-Nicolás Ismael, Poblano-Verástegui Ofelia

机构信息

Research Center for Evaluations and Surveys (CIEE), National Institute of Public Health of Mexico (INSP), Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Mor, Mexico.

出版信息

BMC Pregnancy Childbirth. 2018 May 10;18(1):154. doi: 10.1186/s12884-018-1797-y.

DOI:10.1186/s12884-018-1797-y

PMID:29747588

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5946578/

Abstract

BACKGROUND

The World Health Organization (WHO) launched the "Safe Childbirth Checklist (SCC) Collaboration" in 2012. The SCC is designed to contribute to quality care by providing reminders of evidence-based practices for the prevention and management of the leading causes of maternal and neonatal morbidity and mortality. However, indicators to monitor the implementation and effectiveness of the SCC have not been defined. This study aimed to produce and pilot test a set of valid, reliable and feasible indicators to assess the implementation and effectiveness of the SCC, with an emphasis on best practices.

METHODS

As part of the WHO Collaboration, the SCC was adapted to the Mexican context, and a set of indicators was developed to assess the SCC use and adherence to SCC-related best practices. The indicators were pilot tested in three hospitals for feasibility and reliability using the prevalence- and bias-adjusted kappa index (PABAK) for multiple independent evaluators (initial sample, n = 47; second sample, n = 30 to re-test reliability). The data sources were clinical records and cognitive tests drawn from questionnaires to mothers and health professionals.

RESULTS

We generated 53 indicators, and 38 of the indicators (those related to best practices and outcomes) were pilot tested. Of these, 26 relate to care for the mother (20 were measured based on clinical records and 6 via questionnaire), and 12 relate to newborn care (9 were medical record-based and 3 were from questionnaires). Feasible indicators were generally also reliable (PABAK≥0.6). Routine feasibility is affected by the frequency of assessed events.

CONCLUSIONS

The generated indicators allow an assessment of the implementation and effectiveness of the SCC and the monitoring of quality of care during childbirth and the immediate postpartum period.

摘要

背景

世界卫生组织（WHO）于2012年发起了“安全分娩检查表（SCC）协作项目”。SCC旨在通过提供基于证据的实践提醒，以预防和管理孕产妇及新生儿发病和死亡的主要原因，从而促进优质护理。然而，尚未定义用于监测SCC实施情况和有效性的指标。本研究旨在制定并试点测试一套有效、可靠且可行的指标，以评估SCC的实施情况和有效性，重点关注最佳实践。

方法

作为WHO协作项目的一部分，SCC已根据墨西哥的情况进行了调整，并制定了一套指标来评估SCC的使用情况以及对与SCC相关的最佳实践的遵守情况。使用针对多个独立评估者的患病率和偏差调整kappa指数（PABAK），在三家医院对这些指标进行了可行性和可靠性的试点测试（初始样本，n = 47；第二个样本，n = 30用于重新测试可靠性）。数据来源为临床记录以及从对母亲和卫生专业人员的问卷调查中得出的认知测试。