Using quality improvement to decrease birth asphyxia rates after 'Helping Babies Breathe' training in Kenya
Using quality improvement to decrease birth asphyxia rates after 'Helping Babies Breathe' training in Kenya
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DOI：
10.1111/apa.13940
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发表时间：
2017-10-01
期刊：
影响因子：
3.8
通讯作者：
Kamath-Rayne, Beena D.
中科院分区：
文献类型：
--
作者：
Rule, Amy R. L.;Maina, Esther;Kamath-Rayne, Beena D.
目的：众所周知，帮助婴儿呼吸（HBB）方案可以降低资源匮乏地区的新生儿死亡率，但在护理方面仍然存在差距。本研究描述了使用质量改进来维持HBB后出生窒息相关死亡率的增长。方法：tenweek医院，肯尼亚农村转诊医院，确定了高出生窒息率（BA）。他们制定了一个目标，在HBB后6个月内将疑似缺氧缺血性脑病（SHIE）的发生率降低50%。使用快速变化周期来测试干预措施，包括工作人员/受训人员的培训、保留和参与以及改进的数据收集。随时间变化的运行图表，并使用卡方分析。结果：2014年9月至11月，96名医疗服务提供者接受了HBB。审查了4000多份交货记录。10个月的基线数据显示，SHIE的中位数为14.7/1000活产（LB），差异很大。hbb后10个月，SHIE率下降53%，为7.1/1000 LB （p = 0.01）。SHIE率在最初下降后上升；调查确定，一半受过培训的助产士已被转移。向行政部门提交数据导致工作人员滞留。此后，利率一直保持在目标水平之上，控制范围不断缩小。结论：有针对性的质量改进可以维持和推进hbb培训后新生儿结局的收益。
Aim: The Helping Babies Breathe (HBB) programme is known to decrease neonatal mortality in low-resource settings but gaps in care still exist. This study describes the use of quality improvement to sustain gains in birth asphyxia-related mortality after HBB.Methods: Tenwek Hospital, a rural referral hospital in Kenya, identified high rates of birth asphyxia (BA). They developed a goal to decrease the suspected hypoxic-ischaemic encephalopathy (SHIE) rate by 50% within six months after HBB. Rapid cycles of change were used to test interventions including training, retention and engagement for staff/trainees and improved data collection. Run charts followed the rate over time, and chi-square analysis was used.Results: Ninety-six providers received HBB from September to November 2014. Over 4000 delivery records were reviewed. Ten months of baseline data showed a median SHIE rate of 14.7/1000 live births (LB) with wide variability. Ten months post-HBB, the SHIE rate decreased by 53% to 7.1/1000 LB (p = 0.01). SHIE rates increased after initial decline; investigation determined that half the trained midwives had been transferred. Presenting data to administration resulted in staff retention. Rates have after remained above goal with narrowing control limits.Conclusion: Focused quality improvement can sustain and advance gains in neonatal outcomes post-HBB training.