Centro per la Salute del Bambino, Trieste, Italy.
International perinatal care consultant, Trieste, Italy.
J Glob Health. 2020 Dec;10(2):020432. doi: 10.7189/jogh.10.020432.
A substantial proportion of maternal and neonatal mortality and morbidity is attributable to gaps in quality of care. A systematic, standard-based tool for quality assessment and improvement for maternal and neonatal hospital care (QA/QI MN tool) was developed in 2009 by the World Health Organization (WHO). The tool guides the assessment process along the whole continuum from admission to discharge, collects the views of the recipients of care and engages hospital mangers and staff in identifying gaps and drafting an action plan.
Publications describing use of the WHO QA/QI MN tool from 2009 to 2017 and reports retrievable from WHO or other development partners' websites were searched and considered for inclusion in the review. Only assessments of hospitals were considered. Quality gaps were classified as regarding case management in maternal care, case management in neonatal care, hospital infrastructure, hospital policies and according to severity and frequency. Quotations from women regarding key issues in effective communication, respect and dignity, emotional support and costs incurred were selected.
In the period 2009-2017, use of the WHO QA/QI MN tool was documented in 25 countries, belonging to Central and Eastern Europe (8), Central Asia (4), Sub-Saharan Africa (11), Latin America (1) and Middle East (1). Overall, 133 hospitals were assessed. The tool allowed to identify in great detail serious quality gaps including: insufficient or incomplete adherence to recommended evidence-based procedures for normal childbirth and maternal and neonatal complications; excess of inappropriate or unnecessary interventions; insufficient infection control; failure to provide respectful care, adequate communication and emotional support to mothers and babies; poor use of information generated locally to analyse processes and outcomes. These gaps were observed in all countries. Significant differences were observed among facilities belonging to the same health systems, ie, with very similar staffing, infrastructure and equipment.
The experience made, the largest of this kind, provides comprehensive and detailed insight into the existing quality gaps in a wide variety of settings. QI cycles at facility level should be primarily based on assessments made by multidisciplinary teams of professionals to identify the parts of the care pathways which require improvement through a participatory approach involving managers, staff and patients.
孕产妇和新生儿死亡和发病的很大一部分原因是医疗服务质量存在差距。2009 年，世界卫生组织（世卫组织）开发了一个用于评估和改进孕产妇和新生儿医院护理质量的系统、基于标准的工具（孕产妇和新生儿医院质量评估/改进工具（QA/QI MN 工具））。该工具指导整个入院到出院的评估过程，收集护理接受者的意见，并让医院管理人员和工作人员参与识别差距并起草行动计划。
搜索了 2009 年至 2017 年间描述使用世卫组织 QA/QI MN 工具的出版物以及可从世卫组织或其他发展伙伴网站检索到的报告，并考虑将其纳入审查。仅考虑对医院的评估。将质量差距分为孕产妇护理中的病例管理、新生儿护理中的病例管理、医院基础设施、医院政策以及严重程度和频率。选择了关于有效沟通、尊重和尊严、情感支持以及所涉费用等关键问题的女性的引述。
在 2009 年至 2017 年期间，该工具在 8 个中东欧国家、4 个中亚国家、11 个撒哈拉以南非洲国家、1 个拉丁美洲国家和 1 个中东国家得到使用。共有 133 家医院接受了评估。该工具能够非常详细地确定严重的质量差距，包括：对推荐的循证程序的遵守程度不足或不完整，包括正常分娩和孕产妇及新生儿并发症的处理；过度使用不必要或不适当的干预措施；感染控制不足；未能向产妇和婴儿提供尊重、充分的沟通和情感支持；对当地产生的信息的使用不佳，以分析流程和结果。这些差距在所有国家都存在。属于同一卫生系统的设施之间存在显著差异，即人员配备、基础设施和设备非常相似。
这次经验最丰富，最全面、最详细地了解了各种环境下存在的质量差距。应主要通过多学科专业人员团队的评估来开展机构层面的质量改进循环，通过参与式方法确定需要改进的护理路径部分，该方法涉及管理人员、工作人员和患者。
