背景:巴西是剖腹产率最高的国家之一,达到私营部门近90%的新生儿。设想了一个名为“适当分娩项目(PPA)”的质量改进项目,以减少私营部门的CS。该项目由四个主要组成部分组成:“治理”,“妇女参与”,“护理重组”和“监控”。本文旨在评估:(1)PPA的哪种特定活动对女性阴道分娩的可能性影响最大;(2)PPA的哪种主要成分对阴道分娩的可能性影响最大;(3)结合PPA计划中实施不同活动的情景对阴道分娩的可能性影响更大。
方法:对参加PPA的12家私立医院的样本进行了评估。我们使用贝叶斯网络(BN)来捕获非线性和复杂的因果关系。BN综合了专家的知识和妇女的数据,估计了26个模型参数。在罗布森分类第1-4组的2473名妇女中评估了PPA,他们分为两组:参加或不参加PPA的人。
结果:参与PPA的女性阴道分娩的可能性高出37.7%。导致阴道分娩概率增加的项目最重要的组成部分是“护理重组”,导致产妇阴道分娩的可能性为73%。对分娩类型影响最大的活动是在分娩期间获得最佳实践,阴道分娩的概率为72%.考虑到结合PPA不同活动的12种情况,最好的方案包括:非计划交付,访问有关最佳实践的信息,在分娩期间获得至少4种最佳做法,并尊重生育计划,在最佳组合中阴道分娩的概率为80%。
结论:PPA已被证明是一种有效的质量改进计划,增加了巴西私立医院阴道分娩的可能性。
背景:巴西是全球剖腹产率最高的国家之一,在私人设施中,近90%的分娩是通过CS分娩的。作为回应,“适当分娩项目-PPA”是一项质量改进计划,旨在遏制私人医疗保健中的CS率。其目标是提高分娩质量并减少私人医疗保健中的CS数量。该项目有四个主要部分:\'治理\',“妇女参与”,\'护理重组\',和\'监控\'。
方法:在参与PPA的12家私立医院中进行了一项评估研究,涉及2473名被分为PPA参与者和非参与者的女性。他们使用一种称为因果网络的方法来查看PPA的哪些部分帮助更多的女性进行阴道分娩。
结果:他们发现接受PPA的女性阴道分娩的可能性要高出37.7%。让妇女在分娩和分娩期间获得良好做法非常重要。此外,“护理重组”是该项目的最重要的部分。这导致分娩妇女阴道分娩的可能性为73%。
结论:PPA可有效帮助私立医院的更多妇女进行阴道分娩。这意味着它是改善巴西私立医院分娩的好方案。
BACKGROUND: Brazil is one of the countries with the highest rates of caesarean sections (CS), reaching almost 90% of births in the private sector. A quality improvement project called \"Adequate Childbirth Project (PPA)\" was conceived to reduce CS in the private sector. This project consisted of four primary components: \"Governance\", \"Participation of Women\", \"Reorganization of Care\" and \"Monitoring\". This paper aims to evaluate: (1) which specific activities of the PPA had the largest effect on the probability of a woman having a vaginal delivery; (2) which primary component of the PPA had the largest effect on the probability of vaginal delivery and (3) which scenarios combining the implementation of different activities planned in the PPA had a higher effect on the probability of vaginal delivery.
METHODS: A sample of 12 private hospitals participating in the PPA was evaluated. We used a Bayesian Network (BN) to capture both non-linearities and complex cause-effect relations. The BN integrated knowledge from experts and data from women to estimate 26 model parameters. The PPA was evaluated in 2473 women belonging to groups 1-4 of the Robson classification, who were divided into two groups: those participating or not participating in the PPA.
RESULTS: The probability of a woman having a vaginal delivery was 37.7% higher in women participating in the PPA. The most important component of the project that led to an increase in the probability of vaginal delivery was \"Reorganization of Care\", leading to a 73% probability of vaginal delivery among women in labor. The activity that had the greatest effect on the type of delivery was access to best practices during labor, with a 72% probability of vaginal delivery. Considering the 12 scenarios combining the different activities of the PPA, the best scenarios included: a non-scheduled delivery, access to information about best practices, access to at least 4 best practices during labor and respect of the birth plan, with an 80% probability of vaginal delivery in the best combinations.
CONCLUSIONS: PPA has been shown to be an effective quality improvement program, increasing the likelihood of vaginal delivery in private Brazilian hospitals.
BACKGROUND: Brazil boasts one of the highest rates of caesarean sections (CS) globally, with nearly 90% of births in private facilities being delivered via CS. In response, the \'Adequate Childbirth Project – PPA\' was launched as a quality improvement initiative aimed at curbing CS rates in private healthcare. Its goal is to improve the quality of childbirth and reduce the number of CS in private healthcare. The project has four main parts: \'Governance\', \'Participation of Women\', \'Reorganization of Care\', and \'Monitoring\'.
METHODS: an evaluative study was conducted across 12 private hospitals involved in the PPA, involving 2473 women who were categorized into PPA participants and non-participants. They used a method called a cause-effect network to see which parts of the PPA helped more women have vaginal deliveries.
RESULTS: They found that women in the PPA were 37.7% more likely to have a vaginal delivery. Giving women access to good practices during labor and birth was really important. Also, \'Reorganization of Care\' was the most important part of the project. It led to a 73% chance of vaginal delivery for women in labor.
CONCLUSIONS: The PPA is effective in helping more women in private hospitals have vaginal deliveries. This means it\'s a good program for improving childbirth in Brazil\'s private hospitals.