Improving Quality of Care for Maternal and Newborn Health: Prospective Pilot Study of the WHO Safe Childbirth Checklist Program
Improving Quality of Care for Maternal and Newborn Health: Prospective Pilot Study of the WHO Safe Childbirth Checklist Program
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DOI：
10.1371/journal.pone.0035151
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发表时间：
2012-05-16
期刊：
影响因子：
3.7
通讯作者：
Gawande, Atul
中科院分区：
文献类型：
--
作者：
Spector, Jonathan M.;Agrawal, Priya;Gawande, Atul
背景：在低收入国家，大多数孕产妇死亡、与分娩有关的死产和新生儿死亡都是可以预防的，但还没有设计出简单、有效的方法来提高机构分娩的安全性。基于核对表的干预措施有助于管理复杂或被忽视的任务，并已被证明可以减少医疗保健方面的危害。我们假设，世卫组织安全分娩检查表计划的实施将增加与改善孕产妇和围产期健康结果相关的基本分娩做法的交付。该计划是一项针对机构分娩的新型分娩安全计划，包含29项检查表。方法和结果：2010年7月至12月，在印度卡纳塔克邦的一个子区级生育中心进行了一项试点的干预前研究。我们前瞻性地观察了在499个连续登记的出生事件中护理妇女和新生儿的卫生工作者，并将这些观察到的做法与引入世卫组织安全分娩检查表计划后的795个连续登记的出生事件中观察到的做法进行了比较。评估了29项针对与分娩有关的死亡的主要原因的基本做法，如手卫生和强直性子宫紧张症给药。主要终点是卫生工作者成功实施基本分娩做法的平均比率。在每次分娩活动中提供与分娩相关的基本护理措施的次数从基线时的29次中的平均10次(95%可信区间9.4，10.1)增加到之后29次中的平均25次(95%可信区间24.6，25.3；p<；0.001)。在29项个人实践中，有28项的交付情况有了显著改善。没有发生与干预相关的不良后果。研究的局限性在于研究前的设计，潜在的霍桑效应，以及关注护理过程与健康结果。结论：引入WHO安全分娩检查表计划显著改善了卫生工作者提供基本安全实践的情况。未来的研究将确定这一计划是否能够大规模实施并改善健康结果。
Background: Most maternal deaths, intrapartum-related stillbirths, and newborn deaths in low income countries are preventable but simple, effective methods for improving safety in institutional births have not been devised. Checklist-based interventions aid management of complex or neglected tasks and have been shown to reduce harm in healthcare. We hypothesized that implementation of the WHO Safe Childbirth Checklist program, a novel childbirth safety program for institutional births incorporating a 29-item checklist, would increase delivery of essential childbirth practices linked with improved maternal and perinatal health outcomes.Methods and Findings: A pilot, pre-post-intervention study was conducted in a sub-district level birth center in Karnataka, India between July and December 2010. We prospectively observed health workers that attended to women and newborns during 499 consecutively enrolled birth events and compared these with observed practices during 795 consecutively enrolled birth events after the introduction of the WHO Safe Childbirth Checklist program. Twenty-nine essential practices that target the major causes of childbirth-related mortality, such as hand hygiene and uterotonic administration, were evaluated. The primary end point was the average rate of successful delivery of essential childbirth practices by health workers. Delivery of essential childbirth-related care practices at each birth event increased from an average of 10 of 29 practices at baseline (95% CI 9.4, 10.1) to an average of 25 of 29 practices afterwards (95% CI 24.6, 25.3; p < 0.001). There was significant improvement in the delivery of 28 out of 29 individual practices. No adverse outcomes relating to the intervention occurred. Study limitations are the pre-post design, potential Hawthorne effect, and focus on processes of care versus health outcomes.Conclusions: Introduction of the WHO Safe Childbirth Checklist program markedly improved delivery of essential safety practices by health workers. Future study will determine if this program can be implemented at scale and improve health outcomes.