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Seminars in Perinatology Aug 2016One of the most important purposes of measuring the quality of care is to improve the quality of care. Without measurement, it is not possible to determine whether... (Review)
Review
One of the most important purposes of measuring the quality of care is to improve the quality of care. Without measurement, it is not possible to determine whether changes in medical care delivery are helping patients. This article reviews important concepts in the measurement of quality obstetrical care, and demonstrates how these concepts have been informed by the Assessment of Perinatal Excellence (APEX) study performed by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network.
Topics: Child; Evidence-Based Practice; Female; Fetal Diseases; Humans; National Institute of Child Health and Human Development (U.S.); Obstetrics; Parturition; Pregnancy; Quality Improvement; Quality of Health Care; United States
PubMed: 27210024
DOI: 10.1053/j.semperi.2016.03.009 -
PloS One 2022Mistreatment, discrimination, and poor psycho-social support during childbirth at health facilities are common in lower- and middle-income countries. Despite a policy...
INTRODUCTION
Mistreatment, discrimination, and poor psycho-social support during childbirth at health facilities are common in lower- and middle-income countries. Despite a policy directive from the World Health Organisation (WHO), no operational model exists that effectively demonstrates incorporation of these guidelines in routine facility-based maternity services. This early-phase implementation research aims to develop, implement, and test the feasibility of a service-delivery strategy to promote the culture of supportive and dignified maternity care (SDMC) at public health facilities.
METHODS
Guided by human-centred design approach, the implementation of this study will be divided into two phases: development of intervention, and implementing and testing feasibility. The service-delivery intervention will be co-created along with relevant stakeholders and informed by contextual evidence that is generated through formative research. It will include capacity-building of maternity teams, and the improvement of governance and accountability mechanisms within public health facilities. The technical content will be primarily based on WHO's intrapartum care guidelines and mental health Gap Action Programme (mhGAP) materials. A mixed-method, pre-post design will be used for feasibility assessment. The intervention will be implemented at six secondary-level healthcare facilities in two districts of southern Sindh, Pakistan. Data from multiple sources will be collected before, during and after the implementation of the intervention. We will assess the coverage of the intervention, challenges faced, and changes in maternity teams' understanding and attitude towards SDMC. Additionally, women's maternity experiences and psycho-social well-being-will inform the success of the intervention.
EXPECTED OUTCOMES
Evidence from this implementation research will enhance understanding of health systems challenges and opportunities around SDMC. A key output from this research will be the SDMC service-delivery package, comprising a comprehensive training package (on inclusive, supportive and dignified maternity care) and a field tested strategy to ensure implementation of recommended practices in routine, facility-based maternity care. Adaptation, Implementation and evaluation of SDMC package in diverse setting will be way forward. The study has been registered with clinicaltrials.gov (Registration number: NCT05146518).
Topics: Attitude of Health Personnel; Delivery, Obstetric; Feasibility Studies; Female; Government Programs; Humans; Implementation Science; Infant, Newborn; Maternal Health Services; Maternal Mortality; Obstetrics; Pakistan; Parturition; Perinatal Mortality; Pregnancy; Prenatal Care; Psychosocial Support Systems; Public Health; Quality of Health Care; Respect; Social Inclusion
PubMed: 35139119
DOI: 10.1371/journal.pone.0263635 -
Family Medicine Oct 2023The number of family physicians who include obstetric care in their scope of practice is declining, resulting in lower access for patients to obstetric care, especially...
BACKGROUND AND OBJECTIVES
The number of family physicians who include obstetric care in their scope of practice is declining, resulting in lower access for patients to obstetric care, especially in rural and underserved communities. In our study, we aimed to understand the experiences of mid- to late-career family physicians and capture suggestions regarding how to maintain obstetric deliveries as part of practice throughout their careers.
METHODS
We administered a 30-item online survey to mid- to late-career family physicians regarding their obstetrical care practice and their suggestions for family physicians to continue attending deliveries throughout the course of their career. We developed descriptive statistics of individual and practice characteristics and thematically analyzed open-text comments offering suggestions for continuing to provide obstetric care.
RESULTS
About 1,500 family physicians agreed to participate in the online survey, 992 of whom responded to an open-text question asking for suggestions for family physicians hoping to continue providing obstetric care throughout their careers (56% response rate). The primary themes included suggestions regarding interprofessional relationships, call coverage/backup, training and education, practice characteristics, practice setting, work-life balance, job seeking, policy, and compensation.
CONCLUSIONS
The findings revealed individual- and structural-level considerations to improve longevity in obstetric scope of practice. Support from multiple levels is necessary to ensure that competent family physicians continue attending deliveries throughout their careers. Practices and hospital systems can have a sizeable impact by directly helping family physicians provide obstetric primary care within their scope of practice, while national organizations can influence health care system-level changes.
Topics: Female; Pregnancy; Humans; Physicians, Family; Family Practice; Obstetrics; Surveys and Questionnaires
PubMed: 37540537
DOI: 10.22454/FamMed.2023.966628 -
Midwifery Apr 2015the use of simulation training in obstetrics is an important strategy to improve health-care providers׳ competence to manage obstetric cases. As an increasing number of... (Review)
Review
OBJECTIVE
the use of simulation training in obstetrics is an important strategy to improve health-care providers׳ competence to manage obstetric cases. As an increasing number of international programmes focus on simulation training, more information is needed about the practical aspects of planning for and organising skills laboratories.
METHODS
systematic review of peer reviewed literature published between January 2000 and June 2014. Thematic summary of 31 papers meeting inclusion criteria.
FINDINGS
skills laboratories need to reflect the clinical working environment and are ideally located at or near a health-care facility. A mix of low and high fidelity manikins combined with patient actors is recommended to be used with clear instructions, scenario setting and short lectures including audio-visual teaching aids. Motivated trainers are vital and a focus on 'team training' in smaller groups is beneficial. Practical information needed to set up and run a skills laboratory is provided with a proposed outline of a skills laboratory for obstetric simulation training.
CONCLUSIONS AND IMPLICATIONS FOR PRACTICE
obstetric skills laboratories can play a substantial role in increasing competency and confidence of staff via 'skills and drills' type training. When considering setting up skills laboratories, this can be simply done using low fidelity manikins in the first instance with training facilitated by motivated trainers using realistic clinical scenarios. Overall, the review findings highlight the need for better documentation of factors that promote and/or are barriers to the effective use of skills laboratories.
SYNOPSIS
31 papers detailing the planning and organisation of skills laboratories were reviewed in order to assess the factors necessary for their effectiveness and the vital role they play in increasing staff competencies. Setting up obstetric skills laboratories is worthwhile but requires in-depth planning.
Topics: Clinical Competence; Female; Health Personnel; Humans; Manikins; Obstetrics; Patient Simulation; Pregnancy; Pregnancy Complications
PubMed: 25535017
DOI: 10.1016/j.midw.2014.11.010 -
American Journal of Obstetrics and... Jan 2021
Reengineering academic departments of obstetrics and gynecology to operate in a pandemic world and beyond: a joint American Gynecological and Obstetrical Society and Council of University Chairs of Obstetrics and Gynecology statement.
Topics: Faculty, Medical; Female; Gynecology; Humans; Obstetrics; Pandemics; Pregnancy; United States; Universities
PubMed: 32950475
DOI: 10.1016/j.ajog.2020.09.016 -
Applied Clinical Informatics Aug 2021The American College of Obstetricians and Gynecologists (ACOG) provides numerous narrative documents containing formal recommendations and additional narrative guidance...
BACKGROUND
The American College of Obstetricians and Gynecologists (ACOG) provides numerous narrative documents containing formal recommendations and additional narrative guidance within the text. These guidelines are not intended to provide a complete "care pathway" for patient management, but these elements of guidance can be useful for clinical decision support (CDS) in obstetrical and gynecologic care and could be exposed within electronic health records (EHRs). Unfortunately, narrative guidelines do not easily translate into computable CDS guidance.
OBJECTIVE
This study aimed to describe a method of translating ACOG clinical guidance into clear, implementable items associated with specific obstetrical problems for integration into the EHR.
METHODS
To translate ACOG clinical guidance in Obstetrics into implementable CDS, we followed a set of steps including selection of documents, establishing a problem list, extraction and classification of recommendations, and assigning tasks to those recommendations.
RESULTS
Our search through ACOG clinical guidelines produced over 500 unique documents. After exclusions, and counting only sources relevant to obstetrics, we used 245 documents: 38 practice bulletins, 113 committee opinions, 16 endorsed publications, 1 practice advisory, 2 task force and work group reports, 2 patient education, 2 obstetric care consensus, 60 frequently asked questions (FAQ), 1 women's health care guidelines, 1 Prolog series, and 9 others (non-ACOG). Recommendations were classified as actionable ( = 576), informational ( = 493), for in-house summary ( = 124), education/counseling ( = 170), policy/advocacy ( = 33), perioperative care ( = 4), delivery recommendations ( = 50), peripartum care ( = 13), and non-ACOG ( = 25).
CONCLUSION
We described a methodology of translating ACOG narrative into a semi-structured format that can be more easily applied as CDS in the EHR. We believe this work can contribute to developing a library of information within ACOG that can be continually updated and disseminated to EHR systems for the most optimal decision support. We will continue documenting our process in developing executable code for decision support.
Topics: Female; Humans; Obstetrics; Point-of-Care Systems; Pregnancy; Research Design; United States
PubMed: 34470056
DOI: 10.1055/s-0041-1733933 -
BMC Pregnancy and Childbirth Dec 2012Current recommendations do not support the use of continuous electronic fetal monitoring (EFM) for low risk women during labour, yet EFM remains widespread in clinical... (Review)
Review
BACKGROUND
Current recommendations do not support the use of continuous electronic fetal monitoring (EFM) for low risk women during labour, yet EFM remains widespread in clinical practice. Consideration of the views, perspectives and experiences of individuals directly concerned with EFM application may be beneficial for identifying barriers to and facilitators for implementing evidence-based maternity care. The aim of this paper is to offer insight and understanding, through systematic review and thematic analysis, of research into professionals' views on fetal heart rate monitoring during labour.
METHODS
Any study whose aim was to explore professional views of fetal monitoring during labour was considered eligible for inclusion. The electronic databases of MEDLINE (1966-2010), CINAHL (1980-2010), EMBASE (1974-2010) and Maternity and Infant Care: MIDIRS (1971-2010) were searched in January 2010 and an updated search was performed in March 2012. Quality appraisal of each included study was performed. Data extraction tables were developed to collect data. Data synthesis was by thematic analysis.
RESULTS
Eleven studies, including 1,194 participants, were identified and included in this review. Four themes emerged from the data: 1) reassurance, 2) technology, 3) communication/education and 4) midwife by proxy.
CONCLUSION
This systematic review and thematic analysis offers insight into some of the views of professionals on fetal monitoring during labour. It provides evidence for the continuing use of EFM when caring for low-risk women, contrary to current research evidence. Further research to ascertain how some of these views might be addressed to ensure the provision of evidence-based care for women and their babies is recommended.
Topics: Attitude of Health Personnel; Evidence-Based Medicine; Female; Fetal Monitoring; Humans; Labor, Obstetric; Midwifery; Obstetric Nursing; Obstetrics; Practice Guidelines as Topic; Pregnancy
PubMed: 23270400
DOI: 10.1186/1471-2393-12-166 -
International Journal of Health... Jan 2016In Japan, the number of obstetrics facilities has steadily decreased and the selection and concentration of obstetrics facilities is progressing rapidly. Obstetrics...
BACKGROUND
In Japan, the number of obstetrics facilities has steadily decreased and the selection and concentration of obstetrics facilities is progressing rapidly. Obstetrics services should be concentrated in fewer hospitals to improve quality of care and reduce the workload of obstetricians. However, the impact of this intensification of services on access to obstetrics hospitals is not known. We undertook a simulation to examine how the intensification of obstetrics services would affect access to hospitals based on a variety of scenarios, and the implications for health policy.
METHODS
The female population aged between 15 and 49 living within a 30-min drive of an obstetrics hospital was calculated using a Geographic Information System for three possible intensification scenarios: Scenario 1 retained facilities with a higher volume of deliveries without considering the geographic boundaries of Medical Service Areas (MSAs, zones of healthcare administration and management); Scenario 2 prioritized retaining at least one hospital in each MSA and then retained higher delivery volume institutions, while Scenario 3 retained facilities to maximize population coverage using location-allocation modeling. We also assessed the impact of concentrating services in academic hospitals and specialist perinatal medical centers (PMCs) alone.
RESULTS
In 2011, 95.0% of women aged 15-49 years lived within a 30-min drive of one of 1075 obstetrics hospitals. This would fall to 82.7% if obstetrics services were intensified into academic hospitals and general and regional PMCs. If 55.0% of institutions provided obstetrics services, the coverage would be 87.6% in Scenario 1, whereas intensification based on access would achieve over 90.5% coverage in Scenario 2 and 93.9% in Scenario 3.
CONCLUSIONS
Intensification of obstetrics facilities impairs access, but a greater caseload and better staffing have the potential advantages of better clinical outcomes and reduced costs. It is essential to consult residents of hospital catchment areas when reorganizing clinical services; a simulation is a useful means of informing these important discussions.
Topics: Adult; Delivery of Health Care; Delivery, Obstetric; Female; Geographic Information Systems; Health Services Accessibility; Hospitals; Humans; Japan; Middle Aged; Obstetrics; Pregnancy; Young Adult
PubMed: 26800889
DOI: 10.1186/s12942-016-0035-y -
British Medical Journal Dec 1964
Topics: Delivery, Obstetric; Extraction, Obstetrical; Female; Humans; Obstetrics; Pregnancy
PubMed: 14213066
DOI: 10.1136/bmj.2.5425.1610 -
British Medical Journal Sep 1979
Topics: Blood Transfusion; England; Female; History, 20th Century; Home Care Services; Humans; Obstetric Labor Complications; Obstetrics; Placenta; Pregnancy
PubMed: 387173
DOI: 10.1136/bmj.2.6190.608-c