Assessment of Maternal Referral Systems in Dr. Sardjito General Hospital Using Phyo Referral Score: A Single-Center Preliminary Study

Abstract

Evaluation for referral system of maternal health is a method to decrease maternal mortality rate. Several factors that affecting the quality of referral system are staff, protocols, and geographical access play important roles in the maternal health program. The study aimed to analyze and formulate an evaluation toolkit (Phyo Referral Score/PRS) that can assess the quality of referrals as an instrument for identifying maternal with high-risk complication during labor. This study was qualitative-quantitative (mixed-method) with prospective cohort design which undertaken at Dr. Sardjito General Hospital, Yogyakarta within January and December 2016. The validity, sensitivity, and specificity test were carried out first on the evaluation instrument. Samples were obtained in consecutive patients from obstetric referral at Emergency Department of Dr. Sardjito General Hospital. Statistical analysis was conducted using SPSS v. 19. Statistical analysis was significance if p<0.05. Logical validity test was obtained 93.3% (p=0.001) experts agreed to use PRS. For sensitivity and specificity test were 72.7% and 88.9% respectively. The results of obstetrics evaluation toolkit trial on 20 subjects, consisting of 11 (55%) of patients were categorized as good quality referrals and 9 (45%) patients as poor quality referrals. The result of bivariate analysis showed that the poor quality referral was associated with 21.33 higher risk for incidence of maternal complication (OR: 21.3; 95% CI: 1.81-251.26). In conclusion, PRS shows promise as a toolkit to assess the quality of maternal referrals in Dr. Sardjito General Hospital as the highest tertiary referral hospital in Yogyakarta.

Quality of Emergency Obstetric Referral Practice and Associated Factors Among Mothers Referred to Public Heath Facility in Jimma Zone South West Ethiopia

“…The questionnaire for the structural (inputs) parts which has 6 questions, developed from different literature (10, 19,47) for the referral practice. The availability of input was observed according to the prepared questionnaire in hospital during the study period.…”

“…Structural/Inputs were assessed as if they are present as "Yes" and if they are absent as "No" after that components were counted. Structures/Inputs was said to be poor for score less than mean score and good for score above or equals to the mean score (13,47).…”