UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland.
Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
Lancet Glob Health. 2019 May;7(5):e624-e632. doi: 10.1016/S2214-109X(19)30033-6. Epub 2019 Mar 18.
Ensuring quality of care during pregnancy and childbirth is crucial to improving health outcomes and reducing preventable mortality and morbidity among women and their newborns. In this pursuit, WHO developed a framework and standards, defining 31 quality statements and 352 quality measures to assess and improve quality of maternal and newborn care in health-care facilities. We aimed to assess the capacity of globally used, large-scale facility assessment tools to measure quality of maternal and newborn care as per the WHO framework.
We identified assessment tools through a purposive sample that met the following inclusion criteria: multicountry, facility-level, major focus on maternal and newborn health, data on input and process indicators, used between 2007 and 2017, and currently in use. We matched questions in the tools with 274 quality measures associated with inputs and processes within the WHO standards. We excluded quality measures relating to outcomes because these are not routinely measured by many assessment tools. We used descriptive statistics to calculate how many quality measures could be assessed using each of the tools under review. Each tool was assigned a 1 for fulfilling a quality measure based on the presence of any or all components as indicated in the standards.
Five surveys met our inclusion criteria: the Service Provision Assessment (SPA), developed for the Demographic and Health Surveys programme; the Service Availability and Readiness Assessment, developed by WHO; the Needs Assessment of Emergency Obstetric and Newborn Care developed by the Averting Maternal Death and Disability programme at Columbia University; and the World Bank's Service Delivery Indicator (SDI) and Impact Evaluation Toolkit for Results Based Financing in Health. The proportion of quality measures covered ranged from 62% for the SPA to 12% for the SDI. Although the broadest tool addressed parts of each of the 31 quality statements, 68 (25%) of 274 input and process quality measures were not measured at all. Measures of health information systems and patient experience of care were least likely to be included.
Existing facility assessment tools provide a valuable way to assess quality of maternal and newborn care as one element within the national measurement toolkit. Guidance is clearly needed on priority measures and for better harmonisation across tools to reduce measurement burden and increase data use for quality improvement. Targeted development of measurement modules to address important gaps is a key priority for research.
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确保妊娠和分娩期间的护理质量对于改善妇女及其新生儿的健康结果以及降低可预防的死亡率和发病率至关重要。为此，世卫组织制定了一个框架和标准，确定了 31 项质量声明和 352 项质量措施，以评估和改善医疗保健设施中的孕产妇和新生儿护理质量。我们旨在评估全球使用的大型设施评估工具在多大程度上能够按照世卫组织的框架衡量孕产妇和新生儿护理质量。
我们通过有针对性的抽样确定了评估工具，这些工具符合以下纳入标准：多国家、设施层面、主要关注孕产妇和新生儿健康、关于投入和过程指标的数据、在 2007 年至 2017 年期间使用、目前正在使用。我们将工具中的问题与世卫组织标准中与投入和过程相关的 274 项质量措施相匹配。我们排除了与结果相关的质量措施，因为这些措施并非许多评估工具常规测量。我们使用描述性统计来计算可以使用每种审查工具评估多少项质量措施。每个工具根据标准中规定的任何或所有组件的存在情况，获得 1 分，以满足质量措施。
有 5 项调查符合我们的纳入标准：为人口与健康调查计划制定的服务提供情况评估；世卫组织制定的服务提供情况和准备情况评估；哥伦比亚大学孕产妇死亡和残疾预防项目制定的紧急产科和新生儿护理需求评估；以及世界银行的服务提供指标和基于成果的卫生筹资影响评估工具。涵盖质量措施的比例范围从 SPA 的 62%到 SDI 的 12%。尽管最广泛的工具涵盖了 31 项质量声明中的每一项的部分内容，但仍有 274 项投入和过程质量措施中的 68 项（25%）根本没有测量。卫生信息系统和患者护理体验措施最不可能被包括在内。
现有的设施评估工具为评估孕产妇和新生儿护理质量提供了一种有价值的方法，作为国家衡量工具包的一个要素。显然需要指导优先措施，并更好地协调工具，以减少衡量负担并增加数据用于质量改进。有针对性地开发衡量模块以解决重要差距是研究的一个关键优先事项。
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