Validity and reliability of criterion based clinical audit to assess obstetrical quality of care in West Africa

BMC Pregnancy and Childbirth

Maria-Victoria Zunzunegui²  Mamadou Traore¹  Alexandre Dumont³  Catherine M Pirkle² 

[1] URFOSAME, District health centre of the Commune V, Bamako, Mali;Hospital Research Centres of the University of Montreal Hospital Complex (CRCHUM), Montréal, Canada;Research Institute for Development, Université Paris Descartes, Sorbonne Paris Cité, UMR 216, Paris, France

关键词: Resource-limited settings;    Reliability;    Validity;    Quality of care;    Questionnaire development;    Criterion-based clinical audit;   

Others  :  1152077
DOI  :  10.1186/1471-2393-12-118

 received in 2012-04-16, accepted in 2012-10-22,  发布年份 2012

【 摘 要 】

Background

In Mali and Senegal, over 1% of women die giving birth in hospital. At some hospitals, over a third of infants are stillborn. Many deaths are due to substandard medical practices. Criterion-based clinical audits (CBCA) are increasingly used to measure and improve obstetrical care in resource-limited settings, but their measurement properties have not been formally evaluated. In 2011, we published a systematic review of obstetrical CBCA highlighting insufficient considerations of validity and reliability. The objective of this study is to develop an obstetrical CBCA adapted to the West African context and assess its reliability and validity. This work was conducted as a sub-study within a cluster randomized trial known as QUARITE.

Methods

Criteria were selected based on extensive literature review and expert opinion. Early 2010, two auditors applied the CBCA to identical samples at 8 sites in Mali and Senegal (n = 185) to evaluate inter-rater reliability. In 2010–11, we conducted CBCA at 32 hospitals to assess construct validity (n = 633 patients). We correlated hospital characteristics (resource availability, facility perinatal and maternal mortality) with mean hospital CBCA scores. We used generalized estimating equations to assess whether patient CBCA scores were associated with perinatal mortality.

Results

Results demonstrate substantial (ICC = 0.67, 95% CI 0.54; 0.76) to elevated inter-rater reliability (ICC = 0.84, 95% CI 0.77; 0.89) in Senegal and Mali, respectively. Resource availability positively correlated with mean hospital CBCA scores and maternal and perinatal mortality were inversely correlated with hospital CBCA scores. Poor CBCA scores, adjusted for hospital and patient characteristics, were significantly associated with perinatal mortality (OR 1.84, 95% CI 1.01-3.34).

Conclusion

Our CBCA has substantial inter-rater reliability and there is compelling evidence of its validity as the tool performs according to theory.

Trial registration

Current Controlled Trials ISRCTN46950658

【 授权许可】

   
2012 Pirkle et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Maternal Mortality. Fact sheet N°348. WHO; 2012. http://www.who.int/mediacentre/factsheets/fs348/en/index.html webcite, accessed in October, 2012
• [2]World Health Organization: Neonatal and perinatal mortality: Country, regional, and global estimates 2004. WHO, Geneva; 2007.
• [3]McClure E, Goldenberg R, Bann C: Maternal mortality, stillbirth, and measures of obstetric care in developing and developed countries. Int J Gynecol Obstet 2007, 96(2):139-146.
• [4]Campbell OM, Graham WJ: Strategies for reducing maternal mortality: getting on with what works. Lancet 2006, 368(9543):1284-1299.
• [5]Koblinsky M: Reducing Maternal Mortality: Learning from Bolivia, China, Egypt, Honduras, Indonesia, Jamaica, and Zimbabwe. The World Bank, Washington D.C; 2003.
• [6]Koblinsky M, Matthews Z, Hussein J, Mavalankar D, Mridha MK, Anwar I, Achadi E, Adjei S, Padmanabhan P, van Lerberghe W: Going to scale with professional skilled care. Lancet 2006, 368(9544):1377-1386.
• [7]Dumont A, Fournier P, Fraser W, Haddad S, Traore M, Diop I, Gueye M, Gaye A, Couturier F, Pasquier JC, et al.: QUARITE (quality of care, risk management and technology in obstetrics): a cluster-randomized trial of a multifaceted intervention to improve emergency obstetric care in Senegal and Mali. Trials 2009, 10:85. BioMed Central Full Text
• [8]Jaffré Y, de Olivier Sardan J-P: Une médicine inhospitalitière: les difficiles relations entre soignants et soignés dans cinq capitales d'Afrique de l'Ouest. Karthala, Paris; 2003.
• [9]D'Oliveira AFPL, Diniz SG, Schraiber LB: Violence against women in health-care institutions: an emerging problem. Lancet 2002, 359(9318):1681-1685.
• [10]Bouvier-Colle MH, Ouedraogo C, Dumont A, Vangeenderhuysen C, Salanave B, Decam C: Maternal mortality in West Africa - Rates, causes and substandard care from a prospective survey. Acta Obstet Gynecol Scand 2001, 80(2):113-119.
• [11]Carla A: New estimates of maternal mortality and how to interpret them: choice or confusion? Reprod Health Matters 2011, 19(37):117-128.
• [12]Richardus JH, Graafmans WC, Verloove-Vanhorick SP, Mackenbach JP: The perinatal mortality rate as an indicator of quality of care in international comparisons. Med Care 1998, 36(1):54-66.
• [13]Peabody JW, Tozija F, Munoz JA, Nordyke RJ, Luck J: Using vignettes to compare the quality of clinical care variation in economically divergent countries. Health Serv Res 2004, 39(6 Pt 2):1951-1970.
• [14]Peabody JW, Luck J, Glassman P, Jain S, Hansen J, Spell M, Lee M: Measuring the Quality of Physician Practice by Using Clinical Vignettes: A Prospective Validation Study. Ann Intern Med 2004, 141(10):771-780.
• [15]Pirkle CM, Dumont A, Zunzunegui MV: Criterion-based clinical audit to assess quality of obstetrical care in low- and middle-income countries: a systematic review. Int J Qual Health Care 2011, 23(4):456-463.
• [16]Donabedian A: Evaluating the quality of medical care. Millbank Memorial Fund Quarterly 1966, 44(2):166-203.
• [17]Bailey P, Paxton A, Lobis S, Fry D: The availability of life-saving obstetric services in developing countries: an in-depth look at the signal functions for emergency obstetric care. Int J Gynaecol Obstet 2006, 93(3):285-291.
• [18]World Health Organization, Dept. of Reproductive Health and Research: Beyond the numbers: Reviewing maternal deaths and complications to make pregnancy safer. WHO, Geneva; 2004.
• [19]Graham WJ: Criterion-based clinical audit in obstetrics: bridging the quality gap? Best Pract Res Clin Obstet Gynaecol 2009, 23(3):375-388.
• [20]Shah A, Faundes A, Machoki MI, Bataglia V, Amokrane F, Donner A, Mugerwa K, Carroli G, Fawole B, Langer A, et al.: Methodological considerations in implementing the WHO Global Survey for Monitoring Maternal and Perinatal Health. Bull World Health Organ 2008, 86:126-131.
• [21]Health facility classification score for the WHO Global Survey on Maternal and Perinatal Health in Africa. 2011. http://www.who.int/making_pregnancy_safer/health_systems/global_survey/en/index.html webcite
• [22]Streiner D, Norman G: Health Measurement Scales: a practical guide to their development and use. 4th edition. Oxford University Press, Oxford; 2008.
• [23]Walter S, Eliasziw M, Donner A: Sample size and optimal designs for reliability studies. Stat Med 1998, 17:101-110.
• [24]Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977, 33:159-174.
• [25]WHO: Neonatal and perinatal mortality: Country, regional, and global estimates 2004. WHO, Geneva; 2007.