Outcomes of a Coaching-Based WHO Safe Childbirth Checklist Program in India
Outcomes of a Coaching-Based WHO Safe Childbirth Checklist Program in India
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DOI：
10.1056/nejmoa1701075
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发表时间：
2017-12-14
影响因子：
158.5
通讯作者：
Gawande, Atul A.
中科院分区：
文献类型：
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作者：
Semrau, Katherine E. A.;Hirschhorn, Lisa R.;Gawande, Atul A.
在过去二十年中，在资源匮乏的环境中，设施分娩的流行率急剧上升，但护理质量方面的差距仍然存在，死亡率仍然很高。世界卫生组织（WHO）的安全分娩清单，质量改进工具，促进系统坚持的做法，已与改善分娩outcome.METHODSWe进行了配对，集群随机，对照试验，在60对设施横跨24个地区的北方邦，印度，测试的效果，更好的出生计划，8个月的基于指导的安全分娩清单的实施，对围产期死亡、孕产妇死亡或分娩后7天内孕产妇严重并发症的复合结局进行评估。结果-在分娩后8至42天评估-在干预组和对照组之间进行了比较，并对聚类和匹配进行了调整。我们还比较了干预开始后2个月和12个月时15对配对设施中助产士对18项基本分娩实践的依从性。在161，107名符合条件的妇女中，我们招募了157，689名（97.9%），并确定了157，145名（99.7%）母婴配对的7天结局。在观察的4888例分娩中，干预组的助产士平均实践依从性显著高于对照组（2个月时72.8% vs. 41.7%; 12个月时61.7% vs. 43.9%; P
BACKGROUNDThe prevalence of facility-based childbirth in low-resource settings has increased dramatically during the past two decades, yet gaps in the quality of care persist and mortality remains high. The World Health Organization (WHO) Safe Childbirth Checklist, a quality-improvement tool, promotes systematic adherence to practices that have been associated with improved childbirth outcomes.METHODSWe conducted a matched-pair, cluster-randomized, controlled trial in 60 pairs of facilities across 24 districts of Uttar Pradesh, India, testing the effect of the BetterBirth program, an 8-month coaching-based implementation of the Safe Childbirth Checklist, on a composite outcome of perinatal death, maternal death, or maternal severe complications within 7 days after delivery. Outcomes - assessed 8 to 42 days after delivery - were compared between the intervention group and the control group with adjustment for clustering and matching. We also compared birth attendants' adherence to 18 essential birth practices in 15 matched pairs of facilities at 2 and 12 months after the initiation of the intervention.RESULTSOf 161,107 eligible women, we enrolled 157,689 (97.9%) and determined 7-day outcomes for 157,145 (99.7%) mother-newborn dyads. Among 4888 observed births, birth attendants' mean practice adherence was significantly higher in the intervention group than in the control group (72.8% vs. 41.7% at 2 months; 61.7% vs. 43.9% at 12 months; P