Montagu Dominic, Giessler Katie, Nakphong Michelle Kao, Green Cathy, Roy Kali Prosad, Sahu Ananta Basudev, Sharma Kovid, Sudhinarset May
University of California San Francisco, 550 16th St., San Francisco, CA, USA.
University of California Los Angeles, 650 Charles E. Young Drive South, Los Angeles, CA, 90095-1772, USA.
BMC Health Serv Res. 2020 Dec 4;20(1):1121. doi: 10.1186/s12913-020-05960-6.
Poor patient experiences during delivery leads to delayed presentation at facilities and contributes to poor maternal health outcomes. Person-centered maternity care (PCMC) is a key component of quality. Improving PCMC requires changing the process of care which can be complex and necessitate significant external input, making replication and scale difficult. This study compares the effectiveness two Quality Improvement (QI) intervention phases, one Intensive, one Light-Touch.
We use a matched case-control design to compare two phases of a QI Intervention targeting PCMC, with three facilities in each. The Intensive phase was introduced into three government facilities where teams were supported to identify, design, and test potential improvements over 12 months. The Light-Touch phase was subsequently introduced in three other government facilities and changes were tracked over six months. We compared the two groups using multivariate linear regression and difference-in-difference models to assess changes in PCMC outcome RESULTS: Both Intensive and Light-Touch arms demonstrated large improvements in PCMC. On a scale from 0 to 100, Intensive facilities increased in PCMC scores from 85.02 to 97.13, while Light-Touch facilities increased from 63.42 to 87.47. For both there was a 'halo' effect, with a similar improvement recorded for the specific improvement activities focused on, as w ell as aspects of PCMC not directly addressed.
This study demonstrates that a short, inexpensive, light-touch and directive intervention can change staff practices and significantly improve the experiences of women during childbirth. It also shows that improvements in a few areas of provider-patient interaction have a 'halo' effect, changing many other aspects of patient-provider interaction at the same time.
QI Phase 1 - NCT04208867 . Retrospectively registered. December 19th, 2019. QI Phase 2 - NCT04208841 . Retrospectively registered. December 23, 2019.
分娩过程中患者体验不佳会导致产妇延迟前往医疗机构就诊，并导致不良的孕产妇健康结局。以患者为中心的孕产妇护理（PCMC）是质量的关键组成部分。改善PCMC需要改变护理流程，而这可能很复杂，并且需要大量外部投入，使得复制和扩大规模变得困难。本研究比较了两个质量改进（QI）干预阶段的有效性，一个是强化阶段，一个是轻触阶段。
我们采用匹配病例对照设计，比较针对PCMC的QI干预的两个阶段，每个阶段有三个医疗机构。强化阶段被引入三个政府医疗机构，在12个月内，团队得到支持以识别、设计和测试潜在的改进措施。随后，轻触阶段被引入另外三个政府医疗机构，并对变化进行了六个月的跟踪。我们使用多元线性回归和差异-in-差异模型比较两组，以评估PCMC结局的变化。
强化组和轻触组在PCMC方面均有大幅改善。在0至100的评分范围内，强化医疗机构的PCMC评分从85.02提高到97.13，而轻触医疗机构的评分从63.42提高到87.47。两组都存在 “光环” 效应，针对的特定改进活动以及未直接涉及的PCMC方面都有类似的改善。
本研究表明，一个简短、廉价、轻触式且具有指导性的干预措施可以改变工作人员的行为，并显著改善妇女分娩期间的体验。研究还表明，在医患互动的几个领域的改进具有 “光环” 效应，同时改变了医患互动的许多其他方面。
QI第一阶段 - NCT04208867。追溯注册。2019年12月19日。QI第二阶段 - NCT04208841。追溯注册。2019年12月23日。
