通过质量改进计划将平均动脉压纳入临床实践。
Incorporation of Mean Arterial Pressure in Clinical Practice Using Quality Improvement Initiative.
作者信息
Ansari Sana, Yadav Reena, Jaiswal Nishtha, Chopra Kanika, Kansara Megha, Kumar Manisha
机构信息
Department of Obstetrics and Gynecology, Lady Hardinge Medical College, Shahid Bhagat Singh Marg, New Delhi, 110001 India.
出版信息
J Obstet Gynaecol India. 2025 Apr;75(Suppl 1):449-456. doi: 10.1007/s13224-024-02059-4. Epub 2024 Oct 10.
OBJECTIVES
To increase the practice of measuring mean arterial pressure (MAP) in pregnant women during antenatal check-up from 0 to 70% by 6 months.
METHODS
A quality improvement (QI) team ran multiple Plan-Do-Study-Act (PDSA) cycles. The process measure was two weekly assessments of improvement in MAP measurement. The outcome measure was the proportion of women started on aspirin. The pregnancy outcome of the low-risk and high-risk women were compared.
RESULTS
A total of 360 antenatal women were evaluated. With successive PDSA cycles, which included bridging knowledge gaps; involvement of a multidisciplinary team; involvement of supporting staff; application of software, the MAP measurement improved from 0 to 90% by the end of the study. Total 120/360 (33.3%) cases were deemed high risk based on the presence of maternal risk factors (OR -7.2 , C/I 1.43-36.50). The sensitivity, specificity, PPV and NPV of the test was 75.0%, 70.4%, 5.7%, 99.2% respectively. Total 14/120 (11.7%) cases at high risk of PE were started on aspirin. PE occurred in 6/106 (7.6%) women who were not on aspirin.
CONCLUSION
The successful incorporation of MAP measurement in routine clinical practice could be done in a busy public hospital using POCQI.
目的
在6个月内将产前检查时测量孕妇平均动脉压（MAP）的比例从0提高到70%。
方法
一个质量改进（QI）团队进行了多个计划-执行-研究-行动（PDSA）循环。过程指标是每两周对MAP测量的改进情况进行评估。结果指标是开始服用阿司匹林的女性比例。比较了低风险和高风险女性的妊娠结局。
结果
共评估了360名产前女性。通过连续的PDSA循环，包括弥补知识差距、多学科团队的参与、辅助人员的参与、软件的应用，到研究结束时，MAP测量比例从0提高到了90%。根据产妇风险因素的存在，共有120/360（33.3%）例被视为高风险（OR -7.2，C/I 1.43 - 36.50）。该检测的敏感性、特异性、阳性预测值和阴性预测值分别为75.0%、70.4%、5.7%、99.2%。共有14/120（11.7%）例高风险PE患者开始服用阿司匹林。6/106（7.6%）名未服用阿司匹林的女性发生了PE。
结论
在繁忙的公立医院中，使用POCQI可以成功地将MAP测量纳入常规临床实践。
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