Quality improvement strategies to improve inpatient management of small and sick newborns across All Babies Count supported hospitals in rural Rwanda.
Quality improvement strategies to improve inpatient management of small and sick newborns across All Babies Count supported hospitals in rural Rwanda.
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DOI：
10.1186/s12887-021-02544-z
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发表时间：
2021-02-19
期刊：
影响因子：
2.4
通讯作者：
Kirk CM
中科院分区：
文献类型：
--
作者：
Tuyisenge D;Byiringiro S;Manirakiza ML;Mutsinzi RG;Nshimyiryo A;Nyishime M;Hirschhorn LR;Biziyaremye F;Gitera J;Beck K;Kirk CM
新生儿死亡率占全球儿童死亡的近一半，其中大多数死亡是可以预防的。低质量的护理是低收入和中等收入国家新生儿死亡率的一个主要驱动因素。全婴儿计数（ABC）干预旨在通过提供设备和用品、培训、指导和数据驱动的质量改进（QI）以及通过学习协作会议（LCS）进行对等学习来降低新生儿死亡率。我们的目标是描述从2017年到2019年七个农村地区医院ABC的扩大，重点关注医院新生儿护理单位（ncu）实施的QI战略以及由此产生的新生儿护理结果。在卢旺达的7家农村医院分两个阶段进行了前后准实验研究。第一阶段的基准期为2017年4月至6月，第二阶段为2017年7月至9月；使用2019年同期收集的终端数据。数据包括供应和人员配备的设施审计，LCS对QI技能的调查，以及实施QI改变想法的报告。NCU入院和死亡的数据从健康管理信息系统（HMIS）中提取。工厂报告的改变想法被编码成共同的主题。使用卡方检验测量产后新生儿死亡率的变化。ncu在基线和终点由1名护士（四分位数间距：1 - 2）进行管理。NCU录取人数中位数从121人[IQR: 77-155]增至137人[IQR: 79-184]。先进设备的可用性提高（注射泵：57 - 100%，生命体征监测仪：51 - 100%，CPAP机：14 - 100%）。NCU员工的QI技能有显著提高。所有7个ncu（100%）都将不遵守协议作为优先差距，5个ncu（86%）还改善了与家庭的沟通。NCU病死率从12.4%下降到7.8% （p = 0.001）。ABC一揽子干预措施结合了向NCU提供基本设备、临床培训和强有力的指导、QI指导以及LCS对等学习方法，与干预医院的新生儿死亡率显著降低和服务利用率相关。
Neonatal mortality contributes to nearly half of child deaths globally and the majority of these deaths are preventable. Poor quality of care is a major driver of neonatal mortality in low- and middle-income countries. The All Babies Count (ABC) intervention was designed to reduce neonatal mortality through provision of equipment and supplies, training, mentorship, and data-driven quality improvement (QI) with peer-to-peer learning through learning collaborative sessions (LCS). We aim to describe the ABC scale-up in seven rural district hospitals from 2017 to 2019 focusing on the QI strategies implemented in hospital neonatal care units (NCUs) and the resultant neonatal care outcomes. A pre-post quasi experimental study was conducted in 7 rural hospitals in Rwanda in two phases. The baseline periods were April-June 2017 for Phase I and July-September 2017 for Phase II; with end-line data collected during the same periods in 2019. Data included facility audits of supplies and staffing, LCS surveys of QI skills, and reports of implemented QI change ideas. Data on NCU admissions and deaths were extracted from Health Management Information System (HMIS). Facility-reported change ideas were coded into common themes. Changes in post-post neonatal mortality were measured using Chi-squared tests. NCUs were run by a median of 1 nurse [interquartile range (IQR):1–2] at baseline and endline. Median NCU admissions increased from 121 [IQR: 77–155] to 137 [IQR: 79–184]. Availability of advanced equipment improved (syringe pumps: 57–100 %, vital sign monitors: 51–100 % and CPAP machine: 14–100 %). There were significant improvements in QI skills among NCU staff. All 7 NCUs (100 %) addressed non-adherence to protocol as a priority gap, 5 NCUs (86 %) also improved communication with families. NCU case fatality rate declined from 12.4 to 7.8 % (p = 0.001). The ABC package of interventions combining the provision of essential equipment to NCU, clinical training and strong mentorship, QI coaching, and the LCS approach for peer-to-peer learning was associated with significant neonatal mortality reduction and services utilization in the intervention hospitals.
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DOI：
10.1016/s0140-6736(18)31668-4
发表时间：
2018-11-17
期刊：
Lancet (London, England)
影响因子：
--
作者：
Kruk ME;Gage AD;Joseph NT;Danaei G;García-Saisó S;Salomon JA
通讯作者：
Salomon JA
DOI：
10.1016/j.ijgo.2015.06.062
发表时间：
2016-02-01
影响因子：
3.8
作者：
Tang, Jennifer H.;Kaliti, Charlotte;Wilkinson, Jeffrey
通讯作者：
Wilkinson, Jeffrey
影响因子：
34.3
作者：
Hug, Lucia;Alexander, Monica;Wakefield, John
通讯作者：
Wakefield, John
影响因子：
3.1
作者：
Cavicchiolo ME;Lanzoni P;Wingi MO;Pizzol D;Daverio M;Da Dalt L;Putoto G;Trevisanuto D
通讯作者：
Trevisanuto D
影响因子：
5.4
作者：
Franco, Lynne Miller;Marquez, Lani
通讯作者：
Marquez, Lani