Jhpiego-An Affiliate of Johns Hopkins University, New Delhi, 110020, India.
Department of Health and Family Welfare, NHM, Jaipur, Rajasthan, 302001, India.
BMC Pregnancy Childbirth. 2021 Apr 7;21(1):278. doi: 10.1186/s12884-021-03710-y.
Computerized clinical decision support (CDSS) -digital information systems designed to improve clinical decision making by providers - is a promising tool for improving quality of care. This study aims to understand the uptake of ASMAN application (defined as completeness of electronic case sheets), the role of CDSS in improving adherence to key clinical practices and delivery outcomes.
We have conducted secondary analysis of program data (government data) collected from 81 public facilities across four districts each in two sates of Madhya Pradesh and Rajasthan. The data collected between August -October 2017 (baseline) and the data collected between December 2019 - March 2020 (latest) was analysed. The data sources included: digitized labour room registers, case sheets, referral and discharge summary forms, observation checklist and complication format. Descriptive, univariate and multivariate and interrupted time series regression analyses were conducted.
The completeness of electronic case sheets was low at postpartum period (40.5%), and in facilities with more than 300 deliveries a month (20.9%). In multivariate logistic regression analysis, the introduction of technology yielded significant improvement in adherence to key clinical practices. We have observed reduction in fresh still births rates and asphyxia, but these results were not statistically significant in interrupted time series analysis. However, our analysis showed that identification of maternal complications has increased over the period of program implementation and at the same time referral outs decreased.
Our study indicates CDSS has a potential to improve quality of intrapartum care and delivery outcome. Future studies with rigorous study design is required to understand the impact of technology in improving quality of maternity care.
计算机临床决策支持系统（CDSS）——旨在通过提供者改善临床决策的数字信息系统——是提高医疗质量的一种有前途的工具。本研究旨在了解 ASMAN 应用程序（定义为电子病案的完整性）的采用情况，以及 CDSS 在改善关键临床实践和交付结果方面的作用。
我们对来自马哈拉施特拉邦和拉贾斯坦邦四个地区的 81 个公共设施的项目数据（政府数据）进行了二次分析。分析了 2017 年 8 月至 10 月（基线）和 2019 年 12 月至 2020 年 3 月（最新）收集的数据。数据来源包括：数字化产房登记簿、病案、转诊和出院总结表、观察检查表和并发症格式。进行了描述性、单变量和多变量以及中断时间序列回归分析。
产后期间电子病案的完整性较低（40.5%），每月分娩量超过 300 例的设施中（20.9%）较低。在多变量逻辑回归分析中，引入技术显著提高了对关键临床实践的依从性。我们观察到新鲜死产率和窒息率有所下降，但中断时间序列分析结果无统计学意义。然而，我们的分析表明，在方案实施期间，产妇并发症的识别有所增加，同时转诊量有所减少。
我们的研究表明，CDSS 有可能改善产时护理质量和分娩结果。需要进行严格设计的未来研究，以了解技术在提高产妇护理质量方面的影响。
