Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
BMJ Open. 2022 Oct 3;12(10):e066111. doi: 10.1136/bmjopen-2022-066111.
To examine how characteristics of clinical colleagues influence quality of care.
We conducted a cross-sectional observational study examining the associations between quality of care and a provider's coworkers, controlling for individual provider's characteristics and contextual factors.
Nine health facilities in Dire Dawa Administration, Ethiopia, from December 2020 to February 2021.
824 clients and 95 unique providers were observed across the 9 health facilities.
We examine the quality of processes of intrapartum and immediate postpartum care during five phases of the delivery (first examination, first stage of labour, third stage of labour, immediate newborn care and immediate maternal postpartum care).
For the average client, 50% of the recommended routine clinical actions were completed during the delivery overall, with immediate maternal postpartum care being the least well performed (17% of recommended actions). Multiple healthcare providers were involved in 55% of deliveries. The number of providers contributing to a delivery was unassociated with the quality of care, but a one standard deviation increase in the coworker's performance was associated with a 2% point increase in quality of care (p<0.01); this association was largest among providers in the middle quartiles of performance.
A provider's typical performance had a modest positive association with quality of delivery care given by their coworker. As delivery care is often provided by multiple healthcare providers, examining the dynamics of how they influence one another can provide important insights for quality improvement.
研究临床同事的特点如何影响医疗质量。
我们进行了一项横断面观察性研究，考察了医疗质量与提供者同事之间的关联，同时控制了个体提供者的特征和背景因素。
埃塞俄比亚迪雷达瓦行政区的 9 家卫生机构，时间为 2020 年 12 月至 2021 年 2 月。
在 9 家卫生机构共观察了 824 名客户和 95 名独特的提供者。
我们检查了分娩五个阶段（首次检查、第一产程、第三产程、新生儿即刻护理和产妇即刻产后护理）期间的产程和即刻产后护理的过程质量。
对于一般客户，总体上有 50%的推荐常规临床操作在分娩过程中完成，即时产妇产后护理的执行情况最差（17%的推荐操作）。55%的分娩涉及多名医疗保健提供者。参与分娩的提供者数量与护理质量无关，但同事的表现提高一个标准差与护理质量提高 2 个百分点（p<0.01）相关；这种关联在表现处于中间四分位数的提供者中最大。
提供者的典型表现与其同事提供的分娩护理质量之间存在适度的正相关。由于分娩护理通常由多名医疗保健提供者提供，因此研究他们如何相互影响的动态可以为质量改进提供重要的见解。
