Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
BMJ Open. 2022 Jun 6;12(6):e054544. doi: 10.1136/bmjopen-2021-054544.
To investigate the effect of a quality improvement (QI) package on patient satisfaction of perinatal care.
Secondary analysis of a stepped-wedge cluster-randomised controlled trial. Participating hospitals were randomised by size into four different wedges.
12 secondary-level public hospitals in Nepal.
Women who gave birth in the hospitals at a gestational age of ≥22 weeks, with fetal heart sound at admission. Adverse outcomes were excluded. One hospital was excluded due to data incompleteness and four low-volume hospitals due to large heterogeneity. The final analysis included 54 919 women.
Hospital management was engaged and facilitators were recruited from within hospitals. Available perinatal care was assessed in each hospital, followed by a bottle-neck analysis workshop. A 3-day training in essential newborn care was carried out for health workers involved in perinatal care, and a set of QI tools were introduced to be used in everyday practice (skill-checks, self-assessment checklists, scoreboards and weekly Plan-Do-Study-Act meetings). Refresher training after 6 months.
Women's satisfaction with care during childbirth (a prespecified secondary outcome).
The likelihood of women being overall satisfied with care during childbirth increased after the intervention (adjusted OR (aOR): 1.66, 95% CI: 1.59 to 1.73). However, the proportions of overall satisfaction were low (control 58%, intervention 62%). Women were more likely to be satisfied with education and information from health workers after intervention (aOR: 1.34, 95% CI: 1.29 to 1.40) and to have been treated with dignity and respect (aOR: 1.81, 95% CI: 1.52 to 2.16). The likelihood of having experienced abuse during the hospital stay decreased (aOR: 0.42, 95% CI: 0.34 to 0.51) and of being satisfied with the level of privacy increased (aOR: 1.14, 95% CI: 1.09 to 1.18).
Improvements in patient satisfaction were indicated after the introduction of a QI-package on perinatal care. We recommend further studies on which aspects of care are most important to improve women's satisfaction of perinatal care in hospitals in Nepal.
ISRCTN30829654.
研究质量改进（QI）方案对围产期护理患者满意度的影响。
阶梯式楔形集群随机对照试验的二次分析。参与医院按规模随机分为四个不同的楔形。
尼泊尔的 12 所二级公立医院。
在医院出生的女性，胎龄≥22 周，入院时胎心音正常。排除不良结局。一家医院因数据不完整而被排除，四家低容量医院因异质性太大而被排除。最终分析包括 54919 名妇女。
医院管理层参与，在医院内部招聘促进者。对每家医院的围产期护理进行评估，然后进行瓶颈分析研讨会。对参与围产期护理的卫生工作者进行为期 3 天的基本新生儿护理培训，并引入一套 QI 工具用于日常实践（技能检查、自我评估检查表、记分板和每周的计划-执行-研究-行动会议）。6 个月后进行复习培训。
分娩期间妇女对护理的满意度（预先指定的次要结果）。
干预后，妇女对分娩期间护理的总体满意度增加（调整后的比值比（aOR）：1.66，95%可信区间：1.59 至 1.73）。然而，总体满意度的比例较低（对照组 58%，干预组 62%）。干预后，妇女更有可能对卫生工作者的教育和信息感到满意（aOR：1.34，95%可信区间：1.29 至 1.40），并感到受到尊重（aOR：1.81，95%可信区间：1.52 至 2.16）。住院期间遭受虐待的可能性降低（aOR：0.42，95%可信区间：0.34 至 0.51），对隐私程度的满意度增加（aOR：1.14，95%可信区间：1.09 至 1.18）。
在围产期护理中引入 QI 方案后，患者满意度有所提高。我们建议进一步研究哪些护理方面对提高尼泊尔医院围产期护理中妇女的满意度最重要。
ISRCTN30829654。
