Construction and pilot test of a set of indicators to assess the implementation and effectiveness of the who safe childbirth checklist

Saturno-Hernández, Pedro Jesús; Elorriaga, María Fernández; Martínez-Nicolás, Ismael; Poblano-Verástegui, Ofelia

doi:10.1186/s12884-018-1797-y

Cited by 3 publications

(5 citation statements)

References 24 publications

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“… 41 , 43 , 46 - 52 , 57 , 62 - 65 Other condition specific indicator selection processes in the literature have also emphasised this approach or the absence of it. 19 , 80 - 82 Of note, Hilarion et al articulate that “…indicator development and their application should not be separated” (p. 99). 80 …”

Section: Discussionmentioning

confidence: 99%

Common Features of Selection Processes of Health System Performance Indicators in Primary Healthcare: A Systematic Review

Rendell

Rosewell

Lokuge

et al. 2022

Int J Health Policy Manag

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Background: Health system performance indicators are widely used to assess primary health care (PHC) performance. Despite the numerous tools and some convergence on indicator criteria, there is not a clear understanding of the common features of indicator selection processes. We aimed to review the literature to identify papers that document indicator selection processes for health system performance indicators in PHC. Methods: We searched the online databases Scopus, Medline and CINAHL, as well as the grey literature, without time restrictions, initially on 31 July 2019 followed by an update 13 November 2020. Empirical studies or reports were included if they described the selection of health system performance indicators or frameworks, that included PHC indicators. A combination of the process focussed research question and qualitative analysis meant a quality appraisal tool or assessment of bias could not meaningfully be applied to assess individual studies. We undertook an inductive analysis based on potential indicator selection processes criteria, drawn from health system performance indicator appraisal tools reported in the literature. Results: We identified 16,503 records of which 28 were included in the review. Most studies used a descriptive case study design. We found no consistent variations between indicator selection processes of health systems of high income and low- or lower-middle income countries. Identified common features of selection processes for indicators in PHC include literature review or adaption of an existing framework as an initial step; a consensus building process with stakeholders; structuring indicators into categories; and indicator criteria focusing on validity and feasibility. The evidence around field testing with utility and consideration of reporting burden was less clear. Conclusion: Our findings highlight several characteristics of health system indicator selection processes. These features provide the groundwork to better understand how to value indicator selection processes in primary health care.

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Section: Discussionmentioning

confidence: 99%

Common Features of Selection Processes of Health System Performance Indicators in Primary Healthcare: A Systematic Review

Rendell

Rosewell

Lokuge

et al. 2022

Int J Health Policy Manag

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“…It was developed in the context of the Safe Childbirth Project (approval protocol number 1 562 300/2015), an initiative for the implementation of WHO SCC in hospitals in Brazil and Mexico, which was part of the ‘WHO SCC Collaboration’. The validation of indicators used in the project, 19 20 the descriptive baseline results 4 and the process of adapting the SCC for Brazil 21 have been previously published. The present study tests the hypothesis that the adapted SCC can improve the quality of care during childbirth, both in processes and clinical outcomes.…”

Section: Methodsmentioning

confidence: 99%

“…After training and a pilot study to validate the indicators in both hospitals, 19 20 the data were collected with a prospective review of medical records. The reliability of the instrument during the pilot study in Brazil 20 showed Kappa indices with substantial agreement (>0.76) for most indicators and, when not, adjustments were made for greater clarity.…”

Section: Methodsmentioning

confidence: 99%

Impact of the implementation of the WHO Safe Childbirth Checklist on essential birth practices and adverse events in two Brazilian hospitals: a before and after study

et al. 2022

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ObjectiveThe WHO Safe Childbirth Checklist (SCC) is a promising initiative for safety in childbirth care, but the evidence about its impact on clinical outcomes is limited. This study analysed the impact of SCC on essential birth practices (EBPs), obstetric complications and adverse events (AEs) in hospitals of different profiles.DesignQuasi-experimental, time-series study and pre/post intervention.SettingTwo hospitals in North-East Brazil, one at a tertiary level (H1) and another at a secondary level (H2).Participants1440 women and their newborns, excluding those with congenital malformations.InterventionsThe implementation of the SCC involved its cross-cultural adaptation, raising awareness with videos and posters, learning sessions about the SCC and auditing and feedback on adherence indicators.Primary and secondary outcome measuresSimple and composite indicators related to seven EBPs, 3 complications and 10 AEs were monitored for 1 year, every 2 weeks, totalling 1440 observed deliveries.ResultsThe checklist was adopted in 83.3% (n=300) of deliveries in H1 and in 33.6% (n=121) in H2. The hospital with the highest adoption rate for SCC (H1) showed greater adherence to EBPs (improvement of 50.9%;p<0.001) and greater reduction in clinical outcome indicators compared with its baseline: percentage of deliveries with severe complications (reduction of 30.8%;p=0.005); Adverse Outcome Index (reduction of 25.6%;p=0.049); Weighted Adverse Outcome Score (reduction of 39.5%;p<0.001); Severity Index (reduction of 18.4%;p<0.001). In H2, whose adherence to the SCC was lower, there was an improvement of 24.7% compared with before SCC implementation in the composite indicator of EBPs (p=0.002) and a reduction of 49.2% in severe complications (p=0.027), but there was no significant reduction in AEs.ConclusionsA multifaceted SCC-based intervention can be effective in improving adherence to EBPs and clinical outcomes in childbirth. The context and adherence to the SCC seem to modulate its impact, working better in a hospital of higher complexity.

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“…The variables of interest included simple and composite indicators of GP based on the items contained in the SCC, which were converted into indicators and pilot tested in a previous study,16 and adverse event indicators, which were based on the standardised obstetric quality indicators proposed by Mann et al 17…”

Section: Methodsmentioning

confidence: 99%

“…In both Brazil and Mexico,16 a pilot study was performed to analyse the reliability of the instrument, reaching kappa indices with substantial agreement (>0.76) for most of the indicators; alternatively, adjustments were made to the instrument, aiming for greater clarity and reliability. The pilot study cases were not part of the main study.…”

Section: Methodsmentioning

confidence: 99%

Multicentre cross-sectional study on adverse events and good practices in maternity wards in Brazil and Mexico: same problems, different magnitude

Sousa

Pimenta

Elorriaga³

et al. 2019

BMJ Open

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ObjectiveTo evaluate the quality of delivery care in maternity wards in Brazil and Mexico based on good practices (GP) and adverse events (AE), in order to identify priorities for improvement.DesignA multicentre cross-sectional study with data collection from medical records between 2015 and 2016 to compare indicators of maternal and neonatal GP and EA based on the Safe Childbirth Checklist and standardised obstetric quality indicators. Two Brazilian and five Mexican maternity wards participated in the study. Descriptive statistics and χ2 tests were performed to assess performance and significant differences between the hospitals investigated.SamplingWe analysed 720 births in Brazil and 2707 in Mexico, which were selected using a systematic random sampling of 30 medical records every fortnight for 12 2-week periods in Brazil and 18 2-week periods in Mexico. We included women and their newborns, excluding those with congenital malformations.ResultsThe Mexican hospitals showed greater adherence to GP (58.2%) and a lower incidence of AE (12.9%) than the participating institutions in Brazil (26.8% compliance with GP and 16.0% AE). In spite of these differences, the relative importance of particular quality problems and type of AE are similar in both countries. Tertiary hospitals, caring for women at higher risk, have significantly (p<0.001) higher rates of AE (27.2% in Brazil and 29.6% in Mexico) than institutions attending women at lower risk, where the frequency of AE ranges from 4.7% to 11.2%. Differences were significant (p<0.001) for most indicators of GP and AE.ConclusionData from outcome and process measures revealed similar types of failures in the quality of childbirth care in both countries and indicate the need of rationalising the use of antibiotics for the mother and episiotomy, encouraging greater adherence to partograph and to the use of magnesium sulfate for the treatment of severe preeclampsia/eclampsia.

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Construction and pilot test of a set of indicators to assess the implementation and effectiveness of the who safe childbirth checklist

Cited by 3 publications

References 24 publications

Common Features of Selection Processes of Health System Performance Indicators in Primary Healthcare: A Systematic Review

Common Features of Selection Processes of Health System Performance Indicators in Primary Healthcare: A Systematic Review

Impact of the implementation of the WHO Safe Childbirth Checklist on essential birth practices and adverse events in two Brazilian hospitals: a before and after study

Multicentre cross-sectional study on adverse events and good practices in maternity wards in Brazil and Mexico: same problems, different magnitude

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