The role of digital clinical decision support tool in improving quality of intrapartum and postpartum care: experiences from two states of India

被引:13
作者
Usmanova, Gulnoza [1 ]
Lalchandani, Kamlesh [1 ]
Srivastava, Ashish [1 ]
Joshi, Chandra Shekhar [1 ]
Bhatt, Deepak Chandra [1 ]
Bairagi, Anand Kumar [1 ]
Jain, Yashpal [1 ]
Afzal, Mohammed [1 ]
Dhoundiyal, Rashmi [1 ]
Benawri, Jyoti [1 ]
Chaudhary, Tarun [2 ]
Mishra, Archana [3 ]
Wadhwa, Rajni [4 ]
Sridhar, Pompy [5 ]
Bahl, Nupur [6 ]
Gaikwad, Pratibha [7 ]
Sood, Bulbul [1 ]
机构
[1] Johns Hopkins Univ, New Delhi 110020, India
[2] NHM, Dept Hlth & Family Welf, Jaipur 302001, Rajasthan, India
[3] NHM, Maternal Hlth, Bhopal 462011, Madhya Pradesh, India
[4] ASMAN Alliance Saving Mothers & Newborns, Project Management Unit, Mumbai 400021, Maharashtra, India
[5] MSD Mothers, Mumbai 4000098, Maharashtra, India
[6] Reliance Fdn, Mumbai 400021, Maharashtra, India
[7] Tata Trusts, Mumbai 400005, Maharashtra, India
基金
比尔及梅琳达.盖茨基金会;
关键词
Intrapartum care; Postpartum care; Maternal health; New-born health; CDSS; mHealth; Health information technology; Quality improvement; CASH TRANSFER PROGRAM; HEALTH FACILITIES; SYSTEMS; CHILDBIRTH; TANZANIA; FEATURES; OUTCOMES; BABIES; BIRTHS;
D O I
10.1186/s12884-021-03710-y
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Background Computerized clinical decision support (CDSS) -digital information systems designed to improve clinical decision making by providers - is a promising tool for improving quality of care. This study aims to understand the uptake of ASMAN application (defined as completeness of electronic case sheets), the role of CDSS in improving adherence to key clinical practices and delivery outcomes. Methods We have conducted secondary analysis of program data (government data) collected from 81 public facilities across four districts each in two sates of Madhya Pradesh and Rajasthan. The data collected between August -October 2017 (baseline) and the data collected between December 2019 - March 2020 (latest) was analysed. The data sources included: digitized labour room registers, case sheets, referral and discharge summary forms, observation checklist and complication format. Descriptive, univariate and multivariate and interrupted time series regression analyses were conducted. Results The completeness of electronic case sheets was low at postpartum period (40.5%), and in facilities with more than 300 deliveries a month (20.9%). In multivariate logistic regression analysis, the introduction of technology yielded significant improvement in adherence to key clinical practices. We have observed reduction in fresh still births rates and asphyxia, but these results were not statistically significant in interrupted time series analysis. However, our analysis showed that identification of maternal complications has increased over the period of program implementation and at the same time referral outs decreased. Conclusions Our study indicates CDSS has a potential to improve quality of intrapartum care and delivery outcome. Future studies with rigorous study design is required to understand the impact of technology in improving quality of maternity care.
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页数:12
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