Sarin Enisha, Livesley Nigel
University Research Co, LLC, USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, Maryland, USA.
University Research Co, LLC, USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, Maryland, USA. Correspondence to: Dr Nigel Livesley, University Research Co., LLC, USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, 5404 Wisconsin Avenue, Suite 800, Chevy Chase MD 20815-3594 USA.
Indian Pediatr. 2018 Sep 15;55(9):789-792.
To compare the impact of quality improvement (QI) approaches and other health system factors (level of health facility, cadre of staff conducting the delivery, years of experience of staff conducting the delivery, and time of day) on the quality of six elements of delivery and postpartum/postnatal care.
Cross-sectional study using external observers.
12 public health facilities in 6 states in India during November 2014.
PARTICIPANTS/PATIENTS: 461 deliveries in above facilities.
Facilities were chosen based on having received one day of QI training and at least six monthly QI coaching visits.
MAIN OUTCOME MEASURE(S): (i) Administration of oxytocin within one minute following delivery, (ii) immediate drying and wrapping of the newborn, (iii) use of sterile cord clamps, (iv) breastfeeding within one hour of birth, (v) mothers' condition assessed between 0 and 30 minute after delivery, and (vi) vitamin K given to infants within 6 hour of birth.
On multivariate analysis, facilities using QI approaches with deliberate aims to address the processes of interest were more likely to dry and wrap infants (OR 2.6, 95% CI: 2.1, 6.6), initiate early breastfeeding (OR 3.6, 95% CI: 2.1, 6.2) and conduct post-partum vitals monitoring (OR 2.7, 95% CI: 1.7, 4.2). The other health system factors had mixed effects.
Facilities using QI approaches to ensure all women and babies receive specific elements of care provide that element of care to a greater proportion than facilities not using QI approaches for that element of care.
比较质量改进（QI）方法及其他卫生系统因素（医疗机构级别、实施分娩的工作人员类别、实施分娩的工作人员工作年限以及分娩时间）对分娩及产后/产后护理六个要素质量的影响。
采用外部观察员的横断面研究。
2014年11月印度6个邦的12家公共卫生机构。
参与者/患者：上述机构中的461例分娩。
根据是否接受过为期一天的QI培训以及至少每月接受六次QI指导访视来选择机构。
（i）分娩后一分钟内使用缩宫素；（ii）立即擦干并包裹新生儿；（iii）使用无菌脐带夹；（iv）出生后一小时内进行母乳喂养；（v）分娩后0至30分钟评估母亲状况；（vi）婴儿出生后6小时内给予维生素K。
多因素分析显示，有针对性地采用QI方法来解决相关流程问题的机构更有可能擦干并包裹婴儿（比值比[OR]2.6，95%置信区间[CI]：2.1，6.6）、尽早开始母乳喂养（OR 3.6，95% CI：2.1，6.2）以及进行产后生命体征监测（OR 2.7，95% CI：1.7，4.2）。其他卫生系统因素的影响不一。
与未针对护理要素采用QI方法的机构相比，采用QI方法确保所有妇女和婴儿获得特定护理要素的机构能为更大比例的对象提供该护理要素。
