多方面干预结合审核与反馈对低风险分娩实践的影响：一项多中心前瞻性研究。
Effect of a multifaceted intervention with audit and feedback on low-risk childbirth practice: a multicentre prospective study.
作者信息
Ueda Kayo, Takeshita Mai, Takahashi Yoshimitsu, Sasaki Hatoko, Ozu Naoki, Nakayama Takeo
机构信息
Department of Nursing Women's Health & Midwifery, Faculty of Nursing, Nara Medical University School of Medicine, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan.
Department of Health Informatics, Kyoto University School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan.
出版信息
BMC Pregnancy Childbirth. 2025 May 14;25(1):571. doi: 10.1186/s12884-025-07681-2.
BACKGROUND
Care for low-risk childbirths constitutes a large proportion of deliveries and is highly influenced by factors such as region, birthing facilities, and health care providers. Audit and feedback as a quality indicator (QI) intervention alone have limited effectiveness. Multidisciplinary approaches, including QI and organizational development, are reportedly effective; however, the impact on low-risk childbirth care remains unclear. We aimed to assess the impact of multifaceted intervention, including audit and feedback, on improving care for low-risk childbirths using QIs.
METHODS
We conducted a 1-year pre-post comparison targeting healthy pregnant women in four obstetric wards in Japan. The intervention included audit and feedback combined with multifaceted approaches, improvement efforts by a multidisciplinary team, and educational training on health care quality and organizational culture. The outcomes were 12 QIs. The main analysis used interrupted time-series analysis over 6 months pre- and post-intervention. We compared the 9 months pre-intervention with 3 months post-intervention in secondary analysis to assess delayed effects.
RESULTS
We included 288 women pre-intervention and 167 women post-intervention. "The spontaneous vaginal delivery indicator showed a significant increase in slope (risk ratio [RR] 1∙08, 95% confidence interval [CI]: 1∙00-1∙16, p < 0∙05), indicating a trend-based improvement rather than an immediate change per month in the main analysis. Secondary analysis showed a significant increase in the administration of uterotonic agents during the third stage of labour (RR 1∙19, 95% CI: 1∙01-1∙41, p < 0∙05).
CONCLUSION
The improvement effects of multifaceted interventions, including audit and feedback, using QIs for low-risk childbirths were limited. However, some indicators may improve over time, suggesting a potential delayed effect.
TRIAL REGISTRATION
Not applicable.
背景
低风险分娩护理占分娩总数的很大比例，且受地区、分娩设施和医疗保健提供者等因素的影响很大。仅将审核与反馈作为质量指标（QI）干预措施，其效果有限。据报道，包括QI和组织发展在内的多学科方法是有效的；然而，其对低风险分娩护理的影响仍不明确。我们旨在评估包括审核与反馈在内的多方面干预措施，通过QI改善低风险分娩护理的效果。
方法
我们针对日本四个产科病房的健康孕妇进行了为期1年的干预前后比较。干预措施包括审核与反馈，并结合多方面方法、多学科团队的改进努力以及关于医疗保健质量和组织文化的教育培训。结果指标为12个QI。主要分析采用干预前后6个月的中断时间序列分析。在二次分析中，我们将干预前9个月与干预后3个月进行比较，以评估延迟效应。
结果
我们纳入了干预前的288名女性和干预后的167名女性。“自然阴道分娩指标显示斜率显著增加（风险比[RR]1.08，95%置信区间[CI]：1.00 - 1.16，p < 0.05），这表明在主要分析中是基于趋势的改善，而非每月的即时变化。二次分析显示，产程第三阶段宫缩剂的使用显著增加（RR 1.19，95% CI：1.01 - 1.41，p < 0.05）。
结论
使用QI对低风险分娩进行包括审核与反馈在内的多方面干预措施，其改善效果有限。然而，一些指标可能会随着时间推移而改善，这表明可能存在延迟效应。
试验注册
不适用。
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