Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/31406
Title: Evaluation of a quality improvement intervention for labour and birth care in Brazilian private hospitals: a protocol
Authors: Torres, Jacqueline Alves
Leal, Maria do Carmo
Domingues, Rosa Maria Soares Madeira
Esteves-Pereira, Ana Paula
Nakano, Andreza Rodrigues
Gomes, Maysa Luduvice
Figueiró, Ana Claudia
Nakamura-Pereira, Marcos
de Oliveira, Elaine Fernandes Viellas
Ayres, Bárbara Vasques da Silva
Sandall, Jane
Belizán, José M.
Hartz, Zulmira
Affilliation: Agência Nacional de Saúde Suplementar. Diretoria de Desenvolvimento Setorial. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Casa de Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.
Universidade do Estado do Rio de Janeiro. Faculdade de Enfermagem. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.
King's College London. Department of Women and children's Health. London, England.
Institute for Clinical Effectiveness and Health Policy (IECS). Buenos Aires, Argentina.
Universidade Nova de Lisboa. Instituto de Higiene e Medicina Tropical. Lisboa, Portugal.
Abstract: Background: In Brazilian private hospitals, caesarean section (CS) is almost universal (88%) and is integrated into the model of birth care. A quality improvement intervention, “Adequate Birth” (PPA), based on four driving components (governance, participation of women and families, reorganisation of care, and monitoring), has been implemented to help 23 hospitals reduce their CS rate. This is a protocol designed to evaluate the implementation of PPA and its effectiveness at reducing CS as a primary outcome of birth care. Methods: Case study of PPA intervention conducted in 2017/2018. We integrated quantitative and qualitative methods into data collection and analysis. For the quantitative stage, we selected a convenient sample of twelve hospitals. In each of these hospitals, we included 400 women. This resulted in a total sample of 4800 women. We used this sample to detect a 2.5% reduction in CS rate. We interviewed managers and puerperal women, and extracted data from hospital records. In the qualitative stage, we evaluated a subsample of eight hospitals by means of systematic observation and semi-structured interviews with managers, health professionals and women. We used specific forms for each of the four PPA driving components. Forms for managers and professionals addressed the decision-making process, implemented strategies, participatory process in strategy design, and healthcare practice. Forms for women and neonatal care addressed socio-economic, demographic and health condition; prenatal and birth care; tour of the hospital before delivery; labour expectation vs. real experience; and satisfaction with care received. We will estimate the degree of implementation of PPA strategies related to two of the four driving components: “participation of women and families” and “reorganisation of care”. We will then assess its effect on CS rate and secondary outcomes for each of the twelve selected hospitals, and for the total sample. To allow for clinical, socio-demographic and obstetric characteristics in women, we will conduct multivariate analysis. Additionally, we will evaluate the influence of internal context variables (the PPA driving components “governance” and “monitoring”) on the degree of implementation of the components “participation of women and families” and “reorganisation of care”, by means of thematic content analysis. This analysis will include both quantitative and qualitative data. Discussion: The effectiveness of quality improvement interventions that reduce CS rates requires examination. This study will identify strategies that could promote healthier births.
Keywords: Caesarean section
Health evaluation
Implementation research
Maternal and child health
Parturition
Issue Date: 2018
Publisher: BMC (part os Springer Nature)
Citation: TORRES, Jacqueline Alves et al. Evaluation of a quality improvement intervention for labour and birth care in Brazilian private hospitals: a protocol. Reproductive Health, v. 15, n. 1, p. 194, 2018.
DOI: 10.1186/s12978-018-0636-y
ISSN: 1742-4755
Copyright: open access
Appears in Collections:IFF - Artigos de Periódicos
COC - Artigos de Periódicos
ENSP - Artigos de Periódicos
INI - Artigos de Periódicos

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