Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé) Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France.
Department of Obstetrics and Gynecology, AP-HP Pitié-Salpêtrière, Paris, France.
PLoS One. 2019 Feb 12;14(2):e0211955. doi: 10.1371/journal.pone.0211955. eCollection 2019.
Most indicators proposed for assessing quality of care in obstetrics are process indicators and do not directly measure health effects, and cannot always be identified from routinely available databases. Our objective was to propose a set of indicators to assess the quality of hospital obstetric care from maternal morbidity outcomes identifiable in permanent hospital discharge databases.
Various maternal morbidity outcomes potentially reflecting quality of obstetric care were first selected from a systematic literature review. Then a three-round Delphi consensus survey was conducted online from 11/2016 through 02/2017 among a French panel of 37 expert obstetricians, anesthetists-critical-care specialists, midwives, quality-of-care researchers, and user representatives. For a given maternal outcome, several definitions could be proposed and the indicator (i.e. corresponding rate) could be applied to all women or restricted to specific subgroup(s).
Of the 49 experts invited to participate, 37 agreed. The response rate was 92% in the second round and 97% in the third. Finally, a set of 13 indicators was selected to assess the quality of hospital obstetric care: rates of uterine rupture, postpartum hemorrhage, transfusion incident, severe perineal lacerations, episiotomy, cesarean, cesarean under general anesthesia, post-cesarean site infection, anesthesia-related complications, postpartum pulmonary embolism, maternal readmission and maternal mortality. Six were considered in specific subgroups, with, for example, the postpartum hemorrhage rate assessed among all women and also among women at low risk of PPH.
This Delphi process enabled us to define consensually a set of indicators to assess the quality of hospital obstetrics care from routine hospital data, based on maternal morbidity outcomes. Considering 6 of them in specific subgroups of women is especially interesting. These indicators, identifiable through codes used in international classifications, will be useful to monitor quality of care over time and across settings.
大多数用于评估产科护理质量的指标都是过程指标，不能直接衡量健康效果，而且并非总能从常规可用数据库中确定。我们的目标是提出一套指标，从可在永久性医院出院数据库中识别的产妇发病率结局来评估医院产科护理质量。
首先从系统文献回顾中选择了各种可能反映产科护理质量的产妇发病率结局。然后，2016 年 11 月至 2017 年 2 月期间，通过在线方式在一个由 37 名法国产科医生、麻醉师-重症监护专家、助产士、护理质量研究人员和用户代表组成的专家组中进行了三轮 Delphi 共识调查。对于特定的产妇结局，可以提出多种定义，指标（即相应的比率）可以应用于所有女性或仅限于特定亚组。
在受邀参加的 49 名专家中，有 37 名同意。第二轮的回复率为 92%，第三轮为 97%。最终，选择了 13 个指标来评估医院产科护理质量：子宫破裂率、产后出血率、输血事件率、严重会阴裂伤率、会阴切开率、剖宫产率、全身麻醉下剖宫产率、剖宫产部位感染率、麻醉相关并发症率、产后肺栓塞率、产妇再入院率和产妇死亡率。其中 6 个指标在特定亚组中进行评估，例如，所有女性以及产后出血风险低的女性的产后出血率。
通过这项 Delphi 流程，我们能够根据产妇发病率结局，一致定义一套用于从常规医院数据评估医院产科护理质量的指标。在特定的女性亚组中考虑其中 6 个指标尤其有趣。这些可以通过国际分类使用的代码识别的指标将有助于随着时间的推移和在不同环境中监测护理质量。
