Abstract

Poor quality person-centred maternity care (PCMC) leads to delays in care and adverse maternal and newborn outcomes. This study describes the impact of spreading a Change Package, or interventions that other health facilities had previously piloted and identified as successful, to improve PCMC in public health facilities in Uttar Pradesh, India. A quasi-experimental design was used including matched control-intervention facilities and pre–post data collection. This study took place in Uttar Pradesh, India in 2018–2019. Six large public health facilities participated in the evaluation of the spread study, including three intervention and three control facilities. Intervention facilities were introduced to a quality improvement (QI) Change Package to improve PCMC. In total, 1200 women participated in the study, including 600 women at baseline and 600 women at endline. Difference-in-difference estimators are used to examine the impact of spreading a QI Change Package across spread sites vs. control sites and at baseline and endline using a validated PCMC scale. Out of a 100-point scale, a 24.93 point improvement was observed in overall PCMC scores among spread facilities compared to control facilities from baseline to endline (95% CI: 22.29, 27.56). For the eight PCMC indicators that the Change Package targeted, spread facilities increased 33.86 points (95% CI: 30.91, 36.81) relative to control facilities across survey rounds. Findings suggest that spread of a PCMC Change Package results in improved experiences of care for women as well as secondary outcomes, including clinical quality, nurse and doctor visits, and decreases in delivery problems.

Trial registration: ClinicalTrials.gov identifier: NCT04208841..

摘要

质量差的以人为本的孕产妇保健 (PCMC) 会导致保健延误以及孕产妇和新生儿的不良结局。本研究描述了传播变革包或其他卫生设施先前已试行并确定为成功的干预措施的影响，以改善印度北方邦公共卫生设施的 PCMC。使用了准实验设计，包括匹配的控制干预设施和事前数据收集。这项研究于 2018-2019 年在印度北方邦进行。六家大型公共卫生机构参与了传播研究的评估，其中包括三个干预机构和三个控制机构。在质量改进 (QI) 变更包中引入了干预设施，以改进 PCMC。总共有 1200 名女性参与了这项研究，包括基线时的 600 名女性和终点时的 600 名女性。差中差估计器用于检查使用经过验证的 PCMC 量表在扩展站点与控制站点之间以及在基线和终点线传播 QI 变更包的影响。在 100 分制中，与对照设施相比，从基线到终点，分布设施的总体 PCMC 得分提高了 24.93 分（95% CI：22.29, 27.56）。对于变更包所针对的八项 PCMC 指标，在各轮调查中，与控制设施相比，传播设施增加了 33.86 点（95% CI：30.91, 36.81）。研究结果表明，PCMC 变更包的传播改善了对女性的护理体验以及次要结果，包括临床质量、护士和医生就诊，并减少了分娩问题。

试用注册：ClinicalTrials.gov 标识符：NCT04208841。.