The role of digital clinical decision support tool in improving quality of intrapartum and postpartum care: experiences from two states of India

BMC Pregnancy and Childbirth

Tarun Chaudhary¹  Gulnoza Usmanova²  Bulbul Sood²  Deepak Chandra Bhatt²  Ashish Srivastava²  Jyoti Benawri²  Anand Kumar Bairagi²  Yashpal Jain²  Chandra Shekhar Joshi²  Mohammed Afzal²  Kamlesh Lalchandani²  Rashmi Dhoundiyal²  Pompy Sridhar³  Archana Mishra⁴  Rajni Wadhwa⁵  Nupur Bahl⁶  Pratibha Gaikwad⁷ 

[1] Department of Health and Family Welfare, NHM, 302001, Jaipur, Rajasthan, India;Jhpiego-An Affiliate of Johns Hopkins University, 110020, New Delhi, India;MSD for Mothers, 4000098, Mumbai, India;Maternal Health, NHM, 462011, Bhopal, Madhya Pradesh, India;Project Management Unit, ASMAN: Alliance for Saving Mothers and Newborns, 400021, Mumbai, India;Reliance Foundation, 400021, Mumbai, India;Tata Trusts, 400005, Mumbai, India;

关键词: Intrapartum care;    Postpartum care;    Maternal health;    New-born health;    CDSS;    mHealth;    Health information technology;    Quality improvement;   

DOI  :  10.1186/s12884-021-03710-y

来源: Springer

【 摘 要 】

BackgroundComputerized clinical decision support (CDSS) –digital information systems designed to improve clinical decision making by providers – is a promising tool for improving quality of care. This study aims to understand the uptake of ASMAN application (defined as completeness of electronic case sheets), the role of CDSS in improving adherence to key clinical practices and delivery outcomes.MethodsWe have conducted secondary analysis of program data (government data) collected from 81 public facilities across four districts each in two sates of Madhya Pradesh and Rajasthan. The data collected between August –October 2017 (baseline) and the data collected between December 2019 – March 2020 (latest) was analysed. The data sources included: digitized labour room registers, case sheets, referral and discharge summary forms, observation checklist and complication format. Descriptive, univariate and multivariate and interrupted time series regression analyses were conducted.ResultsThe completeness of electronic case sheets was low at postpartum period (40.5%), and in facilities with more than 300 deliveries a month (20.9%). In multivariate logistic regression analysis, the introduction of technology yielded significant improvement in adherence to key clinical practices. We have observed reduction in fresh still births rates and asphyxia, but these results were not statistically significant in interrupted time series analysis. However, our analysis showed that identification of maternal complications has increased over the period of program implementation and at the same time referral outs decreased.ConclusionsOur study indicates CDSS has a potential to improve quality of intrapartum care and delivery outcome. Future studies with rigorous study design is required to understand the impact of technology in improving quality of maternity care.

【 授权许可】

CC BY