A comparison of intensive vs. light-touch quality improvement interventions for maternal health in Uttar Pradesh, India

Abstract

Background Poor patient experiences during delivery leads to delayed presentation at facilities and contributes to poor maternal health outcomes. Person-centered maternity care (PCMC) is a key component of quality. Improving PCMC requires changing the process of care which can be complex and necessitate significant external input, making replication and scale difficult. This study compares the effectiveness two Quality Improvement (QI) intervention phases, one Intensive, one Light-Touch. Methods We use a matched case-control design to compare two phases of a QI Intervention targeting PCMC, with three facilities in each. The Intensive phase was introduced into three government facilities where teams were supported to identify, design, and test potential improvements over 12 months. The Light-Touch phase was subsequently introduced in three other government facilities and changes were tracked over six months. We compared the two groups using multivariate linear regression and difference-in-difference models to assess changes in PCMC outcome Results Both Intensive and Light-Touch arms demonstrated large improvements in PCMC. On a scale from 0 to 100, Intensive facilities increased in PCMC scores from 85.02 to 97.13, while Light-Touch facilities increased from 63.42 to 87.47. For both there was a ‘halo’ effect, with a similar improvement recorded for the specific improvement activities focused on, as w ell as aspects of PCMC not directly addressed. Conclusions This study demonstrates that a short, inexpensive, light-touch and directive intervention can change staff practices and significantly improve the experiences of women during childbirth. It also shows that improvements in a few areas of provider-patient interaction have a ‘halo’ effect, changing many other aspects of patient-provider interaction at the same time. Trial registration QI Phase 1 - NCT04208867. Retrospectively registered. December 19th, 2019. QI Phase 2 –NCT04208841. Retrospectively registered. December 23, 2019.

Can changes to improve person-centred maternity care be spread across public health facilities in Uttar Pradesh, India?

“…More intense QIC approaches also demonstrate significant improvements in specific PCMC indicators as well as broader patient experience. 26 Because the overall PCMC score also significantly increased by 27 points, this indicates that improvements were made in many aspects of person-centred care, well beyond the indicators and behaviours that were targeted by the QI intervention. This "halo" effect indicates that improvements in targeted aspects of patient experience may have led to changes in non-targeted aspects of patient experience, either because positive experiences in targeted areas of care left patients better disposed to appreciate non-targeted areas of care, or because when providers changed the way they approach and treat patients in some areas of care, this changed approach also influenced and improved other aspects of care that they provided.…”

“…More intense QIC approaches also demonstrate significant improvements in specific PCMC indicators as well as broader patient experience. 26 …”