Improving quality of care for perinatal and newborn care at district and subdistrict hospitals in Haryana, India: Implementation research protocol

다국어 초록 (Multilingual Abstract)

This implementation research aims to improve quality of care for mothers and newborns in three districts of Haryana, India at different public health facilities.
The decline in key maternal and newborn health indicators in India is relatively slower than expected and missed the millennium development goals. The multifold rise in institutional delivery in last decade has limited impact on neonatal and maternal mortality. Despite investments in infrastructure, equipment, supplies, monitoring tools, and also manpower, suboptimal gains in indicators point towards potential challenge in quality of care.
This study adopts pre‐post, quasi‐experimental study design with repeated observations using mixed research methods to document the impact of the plan‐do‐study‐act implementation cycles.
The quality improvement interventions shall be implemented at three district hospitals and six‐first referral unit hospitals in three districts of Haryana targeting the antenatal, delivery, newborn care services with nurses as the key partners. Formative research, situational analysis, and root‐cause analysis shall inform the contextualization, prioritization of interventions. Incremental plan‐do‐study‐act cycles over 15 months shall be implemented. The changes in adherence to protocols, appropriate documentation, reduction in delays, and client satisfaction shall be documented for 16 indicators across delivery, antenatal, and sick newborn care domains.
The successful implementation of the quality improvement processes has the potential of improving the pregnancy outcomes in terms of stillbirths, maternal, and newborn mortality and sick newborn outcomes. The feasibility and learning of coimplementation in the public health system shall inform integration into standards and scaling up.
该实施研究旨在改善印度哈里亚纳邦三个地区不同公共健康机构对母亲和新生儿的护理服务质量。
印度主要孕产妇和新生儿健康指标的下降速度比预期的要慢,没有实现千年发展目标。过去十年机构分娩的多种形式增加对新生儿和产妇死亡率的影响有限。尽管在基础设施、设备、供应品、监测工具以及人力方面进行了投资,但指标的次优增长表明护理服务质量面临潜在挑战。
该研究采用前后测准实验研究设计,使用混合研究方法重复观察,以记录计划‐执行‐研究‐处理循环的影响。
在哈里亚纳邦三个地区的三家区医院和六家首批转诊医院实施质量改进干预,以产前、分娩、新生儿护理服务为目标,以护士为主要合作伙伴。形成性研究、情境分析和根本原因分析应为干预的情境化、优先化提供信息。应实施超过15个月的增量型计划‐执行‐研究‐处理循环。应根据分娩、产前和患病新生儿护理领域的16项指标,记录协议遵从性的变化、适当的文件信息、延迟情况的减少以及客户满意度。
质量改进流程的成功实施有可能会改善死产、孕产妇和新生儿死亡率的妊娠结局以及新生儿患病率。公共健康体系实施的可行性和知识将为纳入标准和扩大规模提供信息。