Applying the Maternal Near Miss Approach for the Evaluation of Quality of Obstetric Care: A Worked Example from a Multicenter Surveillance Study

被引：29

作者：

Haddad, Samira Maerrawi ^{[1
]}

Cecatti, Jose Guilherme ^{[1
,2
]}

Souza, Joao Paulo ^{[1
]}

Sousa, Maria Helena ^{[2
]}

Parpinelli, Mary Angela ^{[1
]}

Costa, Maria Laura ^{[1
]}

Pacagnella, Rodolfo C. ^{[1
]}

Brum, Ione R. ^{[3
]}

Moraes Filho, Olimpio B. ^{[4
]}

Feitosa, Francisco E. ^{[5
]}

Menezes, Carlos A. ^{[6
]}

Guanabara, Everardo M. ^{[7
]}

Moreira, Joaquim L. ^{[8
]}

Peret, Frederico A. ^{[9
]}

Schmaltz, Luiza E. ^{[10
]}

Katz, Leila ^{[11
]}

Barbosa Lima, Antonio C. ^{[12
]}

Amorim, Melania M. ^{[13
]}

Martins, Marilia G. ^{[14
]}

Nascimento, Denis J. ^{[15
]}

Paiva, Claudio S. ^{[16
]}

Rohloff, Roger D. ^{[17
]}

Costa, Sergio M. ^{[18
]}

Luz, Adriana G. ^{[19
]}

Lobato, Gustavo ^{[20
]}

Cordioli, Eduardo ^{[21
]}

Peracoli, Jose C. ^{[22
]}

Maia Filho, Nelson L. ^{[23
]}

Quintana, Silvana M. ^{[24
]}

Lotufo, Fatima A. ^{[25
]}

Andreucci, Carla B. ^{[26
]}

Aquino, Marcia M. ^{[27
]}

Mattar, Rosiane ^{[28
]}

机构：

[1] Univ Campinas UNICAMP, Sch Med Sci, Dept Obstet & Gynaecol, BR-13083881 Campinas, SP, Brazil

[2] Ctr Res Reprod Hlth Campinas Cemicamp, BR-13083888 Campinas, SP, Brazil

[3] Univ Fed Amazonas, Manaus, Amazonas, Brazil

[4] Sch Med Sci, CISAM, Recife, PE, Brazil

[5] Univ Fed Ceara, Fortaleza, Ceara, Brazil

[6] Univ Fed Bahia, Salvador, BA, Brazil

[7] Hosp Geral Cesar Cals, Fortaleza, Ceara, Brazil

[8] Hosp Geral Fortaleza, Fortaleza, Ceara, Brazil

[9] Maternidade Odete Valadares, Belo Horizonte, MG, Brazil

[10] Hosp Materno Infantil, Goiania, Go, Brazil

[11] Inst Materno Infantil Pernambuco, Recife, PE, Brazil

[12] Univ Fed Pernambuco, Recife, PE, Brazil

[13] Univ Fed Campina Grande, Campina Grande, PB, Brazil

[14] Univ Fed Maranhao, Sao Luis, MA, Brazil

[15] Univ Fed Parana, BR-80060000 Curitiba, Parana, Brazil

[16] Univ Fed Paraiba, BR-58059900 Joao Pessoa, Paraiba, Brazil

[17] Hosp Maternidade Fernando Magalhaes, Rio De Janeiro, RJ, Brazil

[18] Univ Fed Rio Grande do Sul, Porto Alegre, RS, Brazil

[19] Hosp Maternidade Celso Pierro, Campinas, SP, Brazil

[20] Inst Fernandes Figueira Fiocruz, Rio De Janeiro, RJ, Brazil

[21] Hosp Israelita Albert Einstein, Sao Paulo, Brazil

[22] Univ State Sao Paulo, Botucatu, SP, Brazil

[23] Jundiai Sch Med, Jundiai, SP, Brazil

[24] Univ Sao Paulo, BR-14049 Ribeirao Preto, SP, Brazil

[25] Santa Casa Limeira, Limeira, SP, Brazil

[26] Santa Casa Sao Carlos, Sao Carlos, SP, Brazil

[27] Maternidade Leonor Mendes de Barros, Sao Paulo, Brazil

[28] Univ Fed Sao Paulo, Sao Paulo, Brazil

来源：

BIOMED RESEARCH INTERNATIONAL | 2014年 / 2014卷

关键词：

NEWBORN HEALTH; MORBIDITY; MORTALITY;

D O I：

10.1155/2014/989815

中图分类号：

Q81 [生物工程学（生物技术）]; Q93 [微生物学];

学科分类号：

071005 ; 0836 ; 090102 ; 100705 ;

摘要：

Objective. To assess quality of care of women with severe maternal morbidity and to identify associated factors. Method. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. The expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed. Results. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase in maternal mortality ratio, the main factors associated with nonadequate performance were geographic difficulty in accessing health services (P < 0.001), delays related to quality of medical care (P = 0.012), absence of blood derivatives (P = 0.013), difficulties of communication between health services (P = 0.004), and any delay during the whole process (P = 0.039). Conclusions. This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. In this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care.

引用

页数：10

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