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AN IMPLEMENTATION ANALYSIS OF A QUALITY IMPROVEMENT PROJECT TO REDUCE CESAREAN SECTION IN BRAZILIAN PRIVATE HOSPITALS
Author
Torres, Jacqueline Alves
Leite, Tatiana Henriques
Fonseca, Thaís Cristina Oliveira
Domingues, Rosa Maria Soares Madeira
Figueiró, Ana Claudia
Pereira, Ana Paula Esteves
Theme‑Filha, Mariza Miranda
Ayres, Bárbara Vasques da Silva
Scott, Oliver
Sanchez, Rita de Cássia
Borem, Paulo
Osti, Maria Carolina de Maio
Rosa, Marcos Wengrover
Andrade, Amanda S.
Peixoto Filho, Fernando Maia
Nakamura‑Pereira, Marcos
Leal, Maria do Carmo
Leite, Tatiana Henriques
Fonseca, Thaís Cristina Oliveira
Domingues, Rosa Maria Soares Madeira
Figueiró, Ana Claudia
Pereira, Ana Paula Esteves
Theme‑Filha, Mariza Miranda
Ayres, Bárbara Vasques da Silva
Scott, Oliver
Sanchez, Rita de Cássia
Borem, Paulo
Osti, Maria Carolina de Maio
Rosa, Marcos Wengrover
Andrade, Amanda S.
Peixoto Filho, Fernando Maia
Nakamura‑Pereira, Marcos
Leal, Maria do Carmo
Affilliation
Institute for Healthcare Improvement. Brasília, DF, Brazil.
State University of Rio de Janeiro. Social Medicine Institute. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Department of Statistical Methods. Rio de Janeiro, RJ, Brazil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. 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.
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.
Cambridge Imperial. London, UK.
Hospital Israelita Albert Einstein. São Paulo, SP, Brasil.
Institute for Healthcare Improvement. Brasília, DF, Brazil.
Hospital da Luz. São Paulo, SP, Brasil.
Hospital Moinhos de Vento. São Paulo, SP, Brasil.
Pasteur Hospital. 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. 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.
State University of Rio de Janeiro. Social Medicine Institute. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Department of Statistical Methods. Rio de Janeiro, RJ, Brazil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. 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.
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.
Cambridge Imperial. London, UK.
Hospital Israelita Albert Einstein. São Paulo, SP, Brasil.
Institute for Healthcare Improvement. Brasília, DF, Brazil.
Hospital da Luz. São Paulo, SP, Brasil.
Hospital Moinhos de Vento. São Paulo, SP, Brasil.
Pasteur Hospital. 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. 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.
Abstract
Background: Brazil has one of the highest prevalence of cesarean sections in the world. The private health system is responsible for carrying out most of these surgical procedures. A quality improvement project called Adequate Childbirth Project ("Projeto Parto Adequado"- PPA) was developed to identify models of care for labor and childbirth, which place value on vaginal birth and reduce the frequency of cesarean sections without a clinical indication. This research aims to evaluate the implementation of PPA in private hospitals in Brazil. Method: Evaluative hospital-based survey, carried out in 2017, in 12 private hospitals, including 4,322 women. We used a Bayesian network strategy to develop a theoretical model for implementation analysis. We estimated and compared the degree of implementation of two major driving components of PPA-"Participation of women" and "Reorganization of care" - among the 12 hospitals and according to type of hospital (belonging to a health insurance company or not). To assess whether the degree of implementation was correlated with the rate of vaginal birth data we used the Bayesian Network and compared the difference between the group "Exposed to the PPA model of care" and the group "Standard of care model". Results: PPA had a low degree of implementation in both components "Reorganization of Care" (0.17 - 0.32) and "Participation of Women" (0.21 - 0.34). The combined implementation score was 0.39-0.64 and was higher in hospitals that belonged to a health insurance company. The vaginal birth rate was higher in hospitals with a higher degree of implementation of PPA. Conclusion: The degree of implementation of PPA was low, which reflects the difficulties in changing childbirth care practices. Nevertheless, PPA increased vaginal birth rates in private hospitals with higher implementation scores. PPA is an ongoing quality improvement project and these results demonstrate the need for changes in the involvement of women and the care offered by the provider.
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