PDF(Pubmed)
Abstract：
BACKGROUND: In 2016, the WHO regional office for Europe prepared a manual for conducting routine facility based individual near miss case review cycle. This study evaluates the effectiveness of the individual near miss case review (NMCR) cycle in improving quality of emergency obstetric care and maternal outcome in Keren hospital.
METHODS: An interrupted time series design was used to achieve the objectives of this study. Monthly data on women with potentially life-threatening conditions (PLTCs) admitted between April 2018 and October 2022 (i.e. 33 months pre-implementation and 22 months post-implementation) were collected from medical records. Segmented regression analysis was used to assess the intervention\'s effect on three process and outcome measures, namely, SMO, delayed care, and substandard care. The intervention was expected a priori to show immediate improvements without time-lag followed by gradual increment in slope. Segmented regression analyses were performed using the \"itsa\' command in STATA.
RESULTS: During the entire study period, 4365 women with potentially life threatening conditions were identified. There was a significant reduction in the post-implementation period in the proportion of mothers with PLTC who experienced SMO (- 8.86; p < 0.001), delayed care (- 8.76; p < 0.001) and substandard care (- 5.58; p < 0.001) compared to pre-implementation period. Results from the segmented regression analysis revealed that the percentage of women with SMO showed a significant 4.75% (95% CI: - 6.95 to - 2.54, p < 0.001) reduction in level followed by 0.28 percentage points monthly (95% CI: - 0.37 to - 0.14, p < 0.001) drop in trend. Similarly, a significant drop of 3.50% (95% CI: - 4.74 to - 2.26, p < 0.001) in the level of substandard care along with a significant decrease of 0.21 percentage points (95% CI: - 0.28 to - 0.14, p < 0.001) in the slope of the regression line was observed. The proportion of women who received delayed care also showed a significant 7% (95% CI: - 9.28 to - 4.68, p < 0.001) reduction in post-implementation level without significant change in slope.
CONCLUSIONS: Our findings suggest that the WHO individual NMCR cycle was associated with substantial improvements in quality of emergency obstetric care and maternal outcome. The intervention also bears a great potential for scaling-up following the guidance provided in the WHO NMCR manual.
METHODS: An interrupted time series design was used to achieve the objectives of this study. Monthly data on women with potentially life-threatening conditions (PLTCs) admitted between April 2018 and October 2022 (i.e. 33 months pre-implementation and 22 months post-implementation) were collected from medical records. Segmented regression analysis was used to assess the intervention\'s effect on three process and outcome measures, namely, SMO, delayed care, and substandard care. The intervention was expected a priori to show immediate improvements without time-lag followed by gradual increment in slope. Segmented regression analyses were performed using the \"itsa\' command in STATA.
RESULTS: During the entire study period, 4365 women with potentially life threatening conditions were identified. There was a significant reduction in the post-implementation period in the proportion of mothers with PLTC who experienced SMO (- 8.86; p < 0.001), delayed care (- 8.76; p < 0.001) and substandard care (- 5.58; p < 0.001) compared to pre-implementation period. Results from the segmented regression analysis revealed that the percentage of women with SMO showed a significant 4.75% (95% CI: - 6.95 to - 2.54, p < 0.001) reduction in level followed by 0.28 percentage points monthly (95% CI: - 0.37 to - 0.14, p < 0.001) drop in trend. Similarly, a significant drop of 3.50% (95% CI: - 4.74 to - 2.26, p < 0.001) in the level of substandard care along with a significant decrease of 0.21 percentage points (95% CI: - 0.28 to - 0.14, p < 0.001) in the slope of the regression line was observed. The proportion of women who received delayed care also showed a significant 7% (95% CI: - 9.28 to - 4.68, p < 0.001) reduction in post-implementation level without significant change in slope.
CONCLUSIONS: Our findings suggest that the WHO individual NMCR cycle was associated with substantial improvements in quality of emergency obstetric care and maternal outcome. The intervention also bears a great potential for scaling-up following the guidance provided in the WHO NMCR manual.
摘要：
背景：2016年，世卫组织欧洲区域办事处编写了一份手册，用于开展基于常规设施的个人近漏诊病例审查周期。这项研究评估了在Keren医院中，个人临近病例审查（NMCR）周期在提高急诊产科护理质量和产妇结局方面的有效性。
方法：使用中断时间序列设计来实现本研究的目标。从医疗记录中收集了2018年4月至2022年10月期间（即实施前33个月和实施后22个月）收治的患有潜在威胁生命疾病（PLTC）的妇女的月度数据。分段回归分析用于评估干预对三个过程和结果指标的影响。即,SMO,延迟护理,和不合标准的护理。预计干预措施会先验地显示出立即的改善，而不会出现时滞，然后斜率逐渐增加。使用STATA中的“itsa”命令进行分段回归分析。
结果：在整个研究期间，确定了4365名可能危及生命的妇女。在实施后期间，患有PLTC的母亲经历过SMO的比例显着降低（-8.86；p<0.001），与实施前相比，延迟护理（-8.76;p<0.001）和不合格护理（-5.58;p<0.001）。分段回归分析结果显示，SMO女性的百分比显示水平显着降低4.75％（95％CI：-6.95至-2.54，p<0.001），随后每月下降0.28个百分点（95％CI：-0.37至-0.14，p<0.001）。同样，观察到不合格护理水平显著下降3.50%(95%CI:-4.74~-2.26,p<0.001),回归线斜率显著下降0.21个百分点(95%CI:-0.28~-0.14,p<0.001).接受延迟护理的女性比例也显示实施后水平显着降低了7％（95％CI：-9.28至-4.68，p<0.001），而斜率没有显着变化。
结论：我们的研究结果表明，WHO个体NMCR周期与产科急诊护理质量和产妇结局的实质性改善有关。根据世卫组织NMCR手册提供的指导，该干预措施还具有扩大规模的巨大潜力。
方法：使用中断时间序列设计来实现本研究的目标。从医疗记录中收集了2018年4月至2022年10月期间（即实施前33个月和实施后22个月）收治的患有潜在威胁生命疾病（PLTC）的妇女的月度数据。分段回归分析用于评估干预对三个过程和结果指标的影响。即,SMO,延迟护理,和不合标准的护理。预计干预措施会先验地显示出立即的改善，而不会出现时滞，然后斜率逐渐增加。使用STATA中的“itsa”命令进行分段回归分析。
结果：在整个研究期间，确定了4365名可能危及生命的妇女。在实施后期间，患有PLTC的母亲经历过SMO的比例显着降低（-8.86；p<0.001），与实施前相比，延迟护理（-8.76;p<0.001）和不合格护理（-5.58;p<0.001）。分段回归分析结果显示，SMO女性的百分比显示水平显着降低4.75％（95％CI：-6.95至-2.54，p<0.001），随后每月下降0.28个百分点（95％CI：-0.37至-0.14，p<0.001）。同样，观察到不合格护理水平显著下降3.50%(95%CI:-4.74~-2.26,p<0.001),回归线斜率显著下降0.21个百分点(95%CI:-0.28~-0.14,p<0.001).接受延迟护理的女性比例也显示实施后水平显着降低了7％（95％CI：-9.28至-4.68，p<0.001），而斜率没有显着变化。
结论：我们的研究结果表明，WHO个体NMCR周期与产科急诊护理质量和产妇结局的实质性改善有关。根据世卫组织NMCR手册提供的指导，该干预措施还具有扩大规模的巨大潜力。
