Applicability of care quality indicators for women with low-risk pregnancies planning hospital birth: a retrospective study of medical records
Applicability of care quality indicators for women with low-risk pregnancies planning hospital birth: a retrospective study of medical records
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DOI：
10.1038/s41598-020-69346-8
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发表时间：
2020-07-27
影响因子：
4.6
通讯作者：
Nakayama，Takeo
中科院分区：
文献类型：
--
作者：
Ueda，Kayo;Sado，Toshiyuki;Nakayama，Takeo
低风险妊娠妇女计划生育的做法因分娩环境、医疗专业和组织系统而异。适当的监控对质量改进至关重要。虽然制订了若干套质量指标，但它们的适用性尚未得到检验。为了提高日本医院低风险母婴的分娩护理质量，我们利用现有临床指南和质量指标制定了35项质量指标。我们回顾性分析了2015年4月至2016年3月期间入院的347名在妊娠中期诊断为低风险妊娠的日本女性的数据。我们获得了35个质量指标的分数，并评估了它们的适用性，即可行性、改进潜力和可靠性（评级内和评级间的可靠性：kappa评分、正一致性和负一致性）。各指标的依从性范围为0-95.7%。我们确定了六个指标的可行性问题，其中超过25%的数据缺失。依从性超过90%的两项指标显示改善潜力有限。三个指标的内部信度kappa评分较差，正/负一致性评分分别为0.94/0.33、0.33/0.95和0.00/0.97。两个指标的kappa评分较差，其正/负一致性评分分别为0.25/0.92和0.68/0.61。研究结果表明，这35个低风险孕妇的护理质量指标可能适用于现实世界的实践，但有一些警告。
Practices for planned birth among women with low-risk pregnancies vary by birth setting, medical professional, and organizational system. Appropriate monitoring is essential for quality improvement. Although sets of quality indicators have been developed, their applicability has not been tested. To improve the quality of childbirth care for low-risk mothers and infants in Japanese hospitals, we developed 35 quality indicators using existing clinical guidelines and quality indicators. We retrospectively analysed data for 347 women in Japan diagnosed with low-risk pregnancy in the second trimester, admitted between April 2015 and March 2016. We obtained scores for 35 quality indicators and evaluated their applicability, i.e., feasibility, improvement potential, and reliability (intra- and inter-rater reliability: kappa score, positive and negative agreement). The range of adherence to each indicator was 0–95.7%. We identified feasibility concerns for six indicators with over 25% missing data. Two indicators with over 90% adherence showed limited potential for improvement. Three indicators had poor kappa scores for intra-rater reliability, with positive/negative agreement scores 0.94/0.33, 0.33/0.95, and 0.00/0.97, respectively. Two indicators had poor kappa scores for inter-rater reliability, with positive/negative agreement scores 0.25/0.92 and 0.68/0.61, respectively. The findings indicated that these 35 care quality indicators for low-risk pregnant women may be applicable to real-world practice, with some caveats.