Department of Population, Family Planning, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
EngenderHealth, 505 9th St NW, Washington, DC, 20004, USA.
BMC Pregnancy Childbirth. 2019 Apr 16;19(1):133. doi: 10.1186/s12884-019-2281-z.
There is a growing recognition that quality of care must improve in facility-based deliveries to achieve further global reductions in maternal and newborn mortality and morbidity. Better measurement of care quality is needed, but the unpredictable length of labor and delivery hinders the feasibility of observation, the gold standard in quality assessment. This study evaluated whether a measure restricted to actions at or immediately following delivery could provide a valid assessment of the quality of the process of intrapartum and immediate postpartum care (QoPIIPC), including essential newborn care.
The study used a comprehensive QoPIIPC index developed through a modified Delphi process and validated by delivery observation data as a starting point. A subset of items from this index assessed at or immediately following delivery was identified to create a "delivery-only" index. This delivery-only index was evaluated across content and criterion validation domains using delivery observation data from Kenya, Madagascar, and Tanzania, including Zanzibar.
The delivery-only index included 13 items and performed well on most validation criteria, including correct classification of poorly and well-performed deliveries. Relative to the comprehensive QoPIIPC index, the delivery-only index had reduced content validity, representing fewer dimensions of QoPIIPC. The delivery-only index was also less strongly associated with overall quality performance in observed deliveries than the comprehensive QoPIIPC index.
Where supervision resources are limited, a measure of the quality of labor and delivery care targeting the time of delivery may mitigate challenges in observation-based assessment. The delivery-only index may enable increased use of observation-based quality assessment within maternal and newborn care programs in low-resource settings.
人们越来越认识到，必须提高医疗机构分娩的护理质量，才能进一步降低全球孕产妇和新生儿的死亡率和发病率。需要更好地衡量护理质量，但分娩和分娩过程的不可预测性阻碍了观察的可行性，而观察是质量评估的金标准。本研究评估了一种仅限于分娩时或分娩后立即采取的措施是否可以对产时和产后即刻护理质量（QoPIIPC）进行有效评估，包括基本新生儿护理。
该研究使用了一种通过改良 Delphi 法制定并通过分娩观察数据验证的全面 QoPIIPC 指数作为起点。从该指数中确定了一些在分娩时或分娩后立即评估的项目，以创建一个“仅分娩”指数。该仅分娩指数在肯尼亚、马达加斯加和坦桑尼亚（包括桑给巴尔）的分娩观察数据中，通过内容和标准验证领域进行了评估。
仅分娩指数包括 13 个项目，在大多数验证标准上表现良好，包括正确分类表现不佳和表现良好的分娩。与全面 QoPIIPC 指数相比，仅分娩指数的内容有效性降低，代表 QoPIIPC 的维度较少。与全面 QoPIIPC 指数相比，仅分娩指数与观察到的分娩的整体质量表现的相关性也较弱。
在监督资源有限的情况下，针对分娩时间的劳动和分娩护理质量衡量标准可能会减轻基于观察的评估挑战。仅分娩指数可能会使资源有限的环境中的孕产妇和新生儿保健计划中更多地使用基于观察的质量评估。
