| Author | Torres, Jacqueline Alves | |
| Author | Leite, Tatiana Henriques | |
| Author | Fonseca, Thaís Cristina Oliveira | |
| Author | Domingues, Rosa Maria Soares Madeira | |
| Author | Figueiró, Ana Claudia | |
| Author | Pereira, Ana Paula Esteves | |
| Author | Theme‑Filha, Mariza Miranda | |
| Author | Ayres, Bárbara Vasques da Silva | |
| Author | Scott, Oliver | |
| Author | Sanchez, Rita de Cássia | |
| Author | Borem, Paulo | |
| Author | Osti, Maria Carolina de Maio | |
| Author | Rosa, Marcos Wengrover | |
| Author | Andrade, Amanda S. | |
| Author | Peixoto Filho, Fernando Maia | |
| Author | Nakamura‑Pereira, Marcos | |
| Author | Leal, Maria do Carmo | |
| Access date | 2025-01-19T02:16:49Z | |
| Available date | 2025-01-19T02:16:49Z | |
| Document date | 2024 | |
| Citation | TORRES, Jacqueline Alves et al. An implementation analysis of a quality improvement project to reduce cesarean section in Brazilian private hospitals. Reproductive Health, v. 20, n. 190, p. 1-16, Apr. 2024. | en_US |
| ISSN | 1742-4755 | en_US |
| URI | https://www.arca.fiocruz.br/handle/icict/68135 | |
| Sponsorship | This work was supported, in part, by the Bill & Melinda Gates Foundation [OPP1142172] and by DECIT/MoH Brazil/CNPq [401715/20159]. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manu‑script version that might arise from this submission. | en_US |
| Language | eng | en_US |
| Publisher | BioMed Central | en_US |
| Rights | open access | |
| Title | An implementation analysis of a quality improvement project to reduce cesarean section in Brazilian private hospitals | en_US |
| Type | Article | en_US |
| DOI | 10.1186/s12978-024-01773-6 | |
| 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. | en_US |
| Affilliation | Institute for Healthcare Improvement. Brasília, DF, Brazil. | en_US |
| Affilliation | State University of Rio de Janeiro. Social Medicine Institute. Rio de Janeiro, RJ, Brazil. | en_US |
| Affilliation | Federal University of Rio de Janeiro. Department of Statistical Methods. Rio de Janeiro, RJ, Brazil. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Cambridge Imperial. London, UK. | en_US |
| Affilliation | Hospital Israelita Albert Einstein. São Paulo, SP, Brasil. | en_US |
| Affilliation | Institute for Healthcare Improvement. Brasília, DF, Brazil. | en_US |
| Affilliation | Hospital da Luz. São Paulo, SP, Brasil. | en_US |
| Affilliation | Hospital Moinhos de Vento. São Paulo, SP, Brasil. | en_US |
| Affilliation | Pasteur Hospital. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Rio de Janeiro, RJ, Brasil. | en_US |
| Affilliation | Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil. | en_US |
| Subject | Vaginal birth | en_US |
| Subject | Implementation analysis | en_US |
| Subject | Bayesian analysis | en_US |
| e-ISSN | 1742-4755 | |
