Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
Department of Gynecology, Hospital Dr. Manuel Gea Gonzalez, Mexico City, Mexico.
Matern Child Health J. 2023 Oct;27(10):1742-1753. doi: 10.1007/s10995-023-03702-8. Epub 2023 Jul 7.
The World Health Organization has adopted two main strategies to improve the quality of maternal health: increasing the number of deliveries by skilled birth attendants and increasing access to emergency obstetric care. Despite increased access to care, there continue to be high rates of maternal morbidity and mortality in part due to quality of care. This study aims to identify and summarize existing frameworks for measuring quality of maternal care at a facility-level.
PubMed, Health Systems Evidence, Embase, Global Health, OVID Healthstar, OVID Medline, PsycINFO, and Web of Science were searched for frameworks, tools, theories, or components of frameworks relevant to maternal quality of care in facility-level settings. Title/abstract and full-text screening were completed by two independent reviewers and conflicts resolved through consensus or a third reviewer.
An initial search resulted in 3182 studies. Fifty-four studies were included in the qualitative analysis. A best fit framework analysis was done using the updated Hulton framework as the conceptual framework. A facility-based maternal quality of care framework is proposed including the following components, separated into provision and experience of care: (1) human resources; (2) infrastructure; (3) equipment, supplies and medicine; (4) evidence and information; (5) referral and networks of care; (6) cultural competence; (7) clinical practice; (8) financing; (9) leadership and governance; (10) cognition; and 11) respect, dignity, equity, and emotional support.
世界卫生组织采用了两种主要策略来提高孕产妇健康质量：增加熟练接生人员的分娩数量和增加获得紧急产科护理的机会。尽管获得了更多的护理机会，但孕产妇发病率和死亡率仍然很高，部分原因是护理质量。本研究旨在确定并总结现有的衡量医疗机构层面孕产妇护理质量的框架。
在 PubMed、Health Systems Evidence、Embase、Global Health、OVID Healthstar、OVID Medline、PsycINFO 和 Web of Science 上搜索与医疗机构层面孕产妇护理质量相关的框架、工具、理论或框架组件。两名独立评审员完成标题/摘要和全文筛选，通过协商或第三名评审员解决冲突。
初步搜索产生了 3182 项研究。54 项研究纳入了定性分析。使用更新的 Hulton 框架作为概念框架进行了最佳拟合框架分析。提出了一个基于医疗机构的孕产妇护理质量框架，包括以下组成部分，分为护理的提供和体验：（1）人力资源；（2）基础设施；（3）设备、用品和药品；（4）证据和信息；（5）转诊和护理网络；（6）文化能力；（7）临床实践；（8）融资；（9）领导力和治理；（10）认知；以及（11）尊重、尊严、公平和情感支持。
