The INCLEN Trust International, New Delhi, India.
Department of Health and Family Welfare, Government of Haryana, Panchkula, Haryana, India.
PLoS One. 2021 Jul 23;16(7):e0254781. doi: 10.1371/journal.pone.0254781. eCollection 2021.
Improving quality of care (QoC) for childbirth and sick newborns is critical for maternal and neonatal mortality reduction. Information on the process and impact of quality improvement at district and sub-district hospitals in India is limited. This implementation research was prioritized by the Haryana State (India) to improve the QoC for maternal and newborn care at the busy hospitals in districts.
This study at nine district and sub-district referral hospitals in three districts (Faridabad, Rewari and Jhajjar) during April 2017-March 2019 adopted pre-post, quasi-experimental study design and plan-do-study-act quality improvement method. During the six quarterly plan-do-study-act cycles, the facility and district quality improvement teams led the gap identification, solution planning and implementation with external facilitation. The external facilitators monitored and collected data on indicators related to maternal and newborn service availability, patient satisfaction, case record quality, provider's knowledge and skills during the cycles. These indicators were compared between baseline (pre-intervention) and endline (post-intervention) cycles for documenting impact.
The interventions closed 50% of gaps identified, increased the number of deliveries (1562 to 1631 monthly), improved care of pregnant women in labour with hypertension (1.2% to 3.9%, p<0.01) and essential newborn care services at birth (achieved ≥90% at most facilities). Antenatal identification of high-risk pregnancies increased from 4.1% to 8.8% (p<0.01). Hand hygiene practices improved from 35.7% to 58.7% (p<0.01). The case record completeness improved from 66% to 87% (p<0.01). The time spent in antenatal clinics declined by 19-42 minutes (p<0.01). The pooled patient satisfaction scores improved from 82.5% to 95.5% (p<0.01). Key challenges included manpower shortage, staff transfers, leadership change and limited orientation for QoC.
This multipronged quality improvement strategy improved the maternal and newborn services, case documentation and patient satisfaction at district and sub-district hospitals. The processes and lessons learned shall be useful for replicating and scaling up.
提高分娩和患病新生儿的护理质量（QoC）对于降低孕产妇和新生儿死亡率至关重要。印度地区和分区医院在质量改进过程和影响方面的信息有限。这项实施研究是由印度哈里亚纳邦（Haryana State）确定的优先事项，旨在改善繁忙地区的地区和分区医院的孕产妇和新生儿护理的 QoC。
本研究于 2017 年 4 月至 2019 年 3 月在三个区（法里达巴德、罗塔里和杰哈杰尔）的九所地区和分区转诊医院进行，采用了前后准实验设计和计划-执行-研究-行动质量改进方法。在六个季度的计划-执行-研究-行动循环中，设施和地区质量改进团队在外部协助下领导差距识别、解决方案规划和实施。外部协助者在循环期间监测和收集与产妇和新生儿服务可用性、患者满意度、病例记录质量、提供者知识和技能相关的指标数据。这些指标在基线（干预前）和终线（干预后）循环之间进行比较，以记录影响。
干预措施解决了 50%的已确定差距，增加了分娩次数（每月从 1562 例增加到 1631 例），改善了患有高血压的孕妇分娩时的护理（从 1.2%增加到 3.9%，p<0.01）和基本新生儿出生时的护理服务（大多数设施达到≥90%）。高危妊娠的产前识别从 4.1%增加到 8.8%（p<0.01）。手卫生操作从 35.7%提高到 58.7%（p<0.01）。病例记录的完整性从 66%提高到 87%（p<0.01）。产前诊所的就诊时间缩短了 19-42 分钟（p<0.01）。患者满意度评分从 82.5%提高到 95.5%（p<0.01）。主要挑战包括人力短缺、人员调动、领导层变更和质量改进的定向有限。
这种多管齐下的质量改进策略改善了地区和分区医院的产妇和新生儿服务、病例记录和患者满意度。所涉及的过程和经验教训将有助于复制和扩大规模。
