International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
BMJ Open. 2023 Sep 27;13(9):e074770. doi: 10.1136/bmjopen-2023-074770.
We assessed the impact of a digital clinical decision support (CDS) tool in improving health providers adherence to recommended antenatal protocols and service quality in rural primary-level health facilities in Burkina Faso.
A quasi-experimental evaluation based on a cross-sectional post-intervention assessment comparing the intervention district to a comparison group.
The study included 331 direct observations and exit interviews of pregnant women seeking antenatal care (ANC) across 48 rural primary-level health facilities in Burkina Faso in 2021.
Digital CDS tool to improve health providers adherence to recommended antenatal protocols.
We analysed the quality of care on both the supply and demand sides. Quality-of-care service scores were based on actual care provided and expected care according to standards. Pregnant women's knowledge of counselling and satisfaction score after receiving care were also calculated. Other outcomes included time of clinical encounter.
The overall quality of health service provision was comparable across intervention and comparison health facilities (52% vs 51%) despite there being a significantly higher proportion of lower skilled providers in the intervention arm (42.5% vs 17.8%). On average, ANC visits were longer in the intervention area (median 24 min, IQR 18) versus comparison area (median 12 min, IQR: 8). The intervention arm had a significantly higher score difference in women's knowledge of received counselling (16.4 points, 95% CI 10.37 to 22.49), and women's satisfaction (16.18 points, 95% CI: 9.95 to 22.40).
Digital CDS tools provide a valuable opportunity to achieve substantial improvements of the quality of ANC and broadly maternal and newborn health in settings with high burden mortality and less trained health cadres when adequately implemented.
我们评估了数字临床决策支持（CDS）工具在改善布基纳法索农村基层卫生机构卫生保健提供者对推荐的产前方案的依从性和服务质量方面的影响。
基于干预后横断面评估的准实验评价，将干预区与对照组进行比较。
这项研究包括 2021 年在布基纳法索的 48 个农村基层卫生机构对 331 名寻求产前保健（ANC）的孕妇进行的 331 次直接观察和退出访谈。
数字 CDS 工具提高卫生保健提供者对推荐的产前方案的依从性。
我们分析了供需双方的护理质量。根据标准，护理质量服务评分基于实际提供的护理和预期护理。还计算了接受护理后孕妇的咨询知识和满意度评分。其他结果包括临床接触时间。
尽管干预组中技能较低的提供者比例（42.5% vs 17.8%）明显较高，但干预和对照卫生机构的整体卫生服务提供质量相当（52% vs 51%）。平均而言，干预区的 ANC 就诊时间更长（中位数 24 分钟，IQR 18），而对照组为（中位数 12 分钟，IQR：8）。干预组在妇女对接受咨询的知识得分差异（16.4 分，95%CI 10.37 至 22.49）和妇女满意度（16.18 分，95%CI：9.95 至 22.40）方面有显著更高的评分差异。
数字 CDS 工具为在高死亡率负担和培训较少的卫生人员的环境中，广泛改善 ANC 和母婴健康质量提供了一个有价值的机会，只要工具得到充分实施。
