关于有哪些证据可用于支持常规监测和评估尊重产妇护理指标的快速综述。
A Rapid Review of Available Evidence to Inform Indicators for Routine Monitoring and Evaluation of Respectful Maternity Care.
机构信息
Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.
Independent consultant.
出版信息
Glob Health Sci Pract. 2020 Mar 31;8(1):125-135. doi: 10.9745/GHSP-D-19-00323. Print 2020 Mar 30.
BACKGROUND
Some opportunities to routinely capture and improve respectful maternity care (RMC) during facility-based childbirth include quality improvement (QI) initiatives, community-based monitoring efforts through community score cards (CSC), and performance-based financing (PBF) initiatives. But there is limited guidance on which types of RMC indicators are best suited for inclusion in these initiatives. We sought to provide practical evidence-based recommendations on indicators that may be used for routine measurement of RMC in programs.
METHODS
We used a rapid review approach, which included (1) reviewing existing documents and publications to extract RMC indicators and identify which have or can be used in facility-based QI, CSCs, and PBF schemes; (2) surveying RMC and maternal health experts to rank indicators, and (3) analyzing survey data to select the most recommended indicators.
RESULTS
We identified 49 indicators spanning several domains of RMC and mistreatment including dignified/nondignified care, verbal and physical abuse, privacy/confidentiality, autonomy/loss of autonomy, supportive care/lack thereof, communication, stigma, discrimination, trust, facility environment/culture, responsiveness, and nonevidence-based care. Based on the analysis of the survey data, we recommend 33 indicators (between 2 and 6 indicators for each RMC domain) that may be suited for incorporation in both facility-based QI and CSC-related monitoring efforts.
CONCLUSION
Integrating RMC indicators into QI and CSC initiatives, as well as in other maternal and neonatal health programs, could help improve RMC at the facility and community level. More research is needed into whether RMC can be integrated into PBF initiatives. Integration of RMC indicators into programs to improve quality of care and other health system outcomes will facilitate routine monitoring and accountability around experience of care. Measurement and improvement of women's experiences will increase maternal health service utilization and improve quality of care as a means of reducing maternal and neonatal morbidity and mortality.
背景
在医疗机构分娩过程中，有一些机会可以常规收集和改进尊重产妇护理（RMC），包括质量改进（QI）举措、通过社区记分卡（CSC）进行的基于社区的监测工作以及基于绩效的融资（PBF）举措。但是，关于哪些类型的 RMC 指标最适合纳入这些举措，指导有限。我们旨在为在项目中常规测量 RMC 可能使用的指标提供实用的循证建议。
方法
我们使用快速审查方法，包括：（1）审查现有文件和出版物，以提取 RMC 指标并确定哪些指标已经或可以在医疗机构 QI、CSC 和 PBF 计划中使用；（2）调查 RMC 和产妇健康专家对指标进行排名；（3）分析调查数据以选择最推荐的指标。
结果
我们确定了 49 个指标，涵盖了 RMC 和虐待的几个领域，包括有尊严/无尊严的护理、言语和身体虐待、隐私/保密性、自主权/自主权丧失、支持性护理/缺乏支持性护理、沟通、耻辱感、歧视、信任、设施环境/文化、响应能力和非基于证据的护理。基于对调查数据的分析，我们建议纳入 33 个指标（每个 RMC 领域 2 到 6 个指标之间），这些指标可能适合纳入医疗机构 QI 和 CSC 相关监测工作。
结论
将 RMC 指标纳入 QI 和 CSC 举措以及其他母婴健康计划中，有助于改善医疗机构和社区层面的 RMC。还需要更多研究来探讨 RMC 是否可以纳入 PBF 举措。将 RMC 指标纳入改善护理质量和其他卫生系统成果的计划，将促进对护理体验的常规监测和问责制。衡量和改善妇女的体验将增加产妇保健服务的利用，并改善护理质量，从而降低母婴发病率和死亡率。
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