Using a quality improvement model to enhance providers’ performance in maternal and newborn health care: a post-only intervention and comparison design

BMC Pregnancy and Childbirth

Research Article

Jos van Roosmalen¹  Jelle Stekelenburg²  Gizachew Eyassu³  Ephrem Daniel³  Negash Seyoum³  Firew Ayalew³  Alemnesh Tekleberhan³  Hannah Gibson³  Eva Bazant⁴  Young Mi Kim⁴ 

[1] Athena Institute, VU University, Amsterdam, The Netherlands;Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands;Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands;Jhpiego Ethiopia, Addis Ababa, Ethiopia;Jhpiego, 1615 Thames St # 200, 21231, Baltimore, MD, USA;

关键词: SBM-R;    Ethiopia;    Antenatal care;    Postnatal care;    Labor and delivery;    Provider performance;    Quality improvement;    Maternal health;    Newborn health;   

DOI  :  10.1186/s12884-017-1303-y

 received in 2016-11-26, accepted in 2017-04-07,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe Standards Based Management and Recognition (SBM-R©) approach to quality improvement has been implemented in Ethiopia to strengthen routine maternal and newborn health (MNH) services. This evaluation assessed the effect of the intervention on MNH providers’ performance of routine antenatal care (ANC), uncomplicated labor and delivery and immediate postnatal care (PNC) services.MethodsA post-only evaluation design was conducted at three hospitals and eight health centers implementing SBM-R and the same number of comparison health facilities. Structured checklists were used to observe MNH providers’ performance on ANC (236 provider-client interactions), uncomplicated labor and delivery (226 provider-client interactions), and immediate PNC services in the six hours after delivery (232 provider-client interactions); observations were divided equally between intervention and comparison groups. Main outcomes were provider performance scores, calculated as the percentage of essential tasks in each service area completed by providers. Multilevel analysis was used to calculate adjusted mean percentage performance scores and standard errors to compare intervention and comparison groups.ResultsThere was no statistically significant difference between intervention and comparison facilities in overall mean performance scores for ANC services (63.4% at intervention facilities versus 61.0% at comparison facilities, p = 0.650) or in any specific ANC skill area. MNH providers’ overall mean performance score for uncomplicated labor and delivery care was 11.9 percentage points higher in the intervention than in the comparison group (77.5% versus 65.6%; p = 0.002). Overall mean performance scores for immediate PNC were 22.2 percentage points higher at intervention than at comparison facilities (72.8% versus 50.6%; p = 0.001); and there was a significant difference of 22 percentage points between intervention and comparison facilities for each PNC skill area: care for the newborn and health check for the mother.ConclusionsThe SBM-R quality improvement intervention made a significant positive impact on MNH providers’ performance during labor and delivery and immediate PNC services, but not during ANC services. Scaling up the intervention to other facilities and regions may increase the availability of good quality MNH services across Ethiopia. The findings will also guide implementation of the government’s five-year (2015–2020) health sector transformation plan and health care quality strategies needed to meet the country’s MNH goals.

【 授权许可】

CC BY   
© The Author(s). 2017