Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America.
School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States of America.
PLoS One. 2020 Dec 11;15(12):e0242909. doi: 10.1371/journal.pone.0242909. eCollection 2020.
Poor patient experiences during delivery in Uttar Pradesh, India is a common problem. It delays presentation at facilities after the onset of labor and contributes to poor maternal health outcomes. Patient-centered maternity care (PCMC) is recognized by the World Health Organization as critical to overall quality. Changing PCMC requires changing the process of care, and is therefore especially challenging.
We used a matched case-control design to evaluate a quality improvement process directed at PCMC and based on widely established team-based methods used in many OECD countries. The intervention was introduced into three government facilities and teams supported to brainstorm and test improvements over 12 months. Progress was measured through pre-post interviews with new mothers, scored using a validated PCMC scale. Analysis included chi-squared and difference-in-difference tests.
On a scale to 100, the PCMC score of the intervention group increased 22.9 points compared to controls. Deliveries attended by midwives, dais, ASHAs or non-skilled providers resulted in significantly higher PCMC scores than those attended to by nurses or doctors. The intervention was associated with one additional visit from a doctor and over two additional visits from nurses per day, compared to the control group.
This study has demonstrated the effectiveness of a team-based quality improvement intervention to ameliorate women's childbirth experiences. These improvements were locally designed and led, and offer a model for potential replication.
印度北方邦分娩期间患者体验较差是一个普遍问题。这会导致产妇在分娩开始后延迟到医疗机构就诊，并导致产妇健康状况不佳。以患者为中心的产妇保健（PCMC）被世界卫生组织认为是整体质量的关键。改变 PCMC 需要改变护理流程，因此尤其具有挑战性。
我们使用了匹配病例对照设计来评估一项针对 PCMC 的质量改进过程，该过程基于在许多经合组织国家广泛使用的基于团队的既定方法。该干预措施被引入到三个政府机构中，并支持团队在 12 个月内集思广益并测试改进措施。通过对新妈妈进行预-后访谈，使用经过验证的 PCMC 量表进行评分来衡量进展。分析包括卡方检验和差异检验。
在 100 分的 PCMC 评分中，干预组的评分比对照组高 22.9 分。与由护士或医生接生的分娩相比，由助产士、接生婆、ASHAs 或非熟练提供者接生的分娩的 PCMC 评分显著更高。与对照组相比，干预组每天额外增加了一次医生就诊和两次以上的护士就诊。
本研究证明了基于团队的质量改进干预措施可以改善女性的分娩体验，这种改善是在当地设计和领导的，并为潜在的复制提供了一种模式。
