Improving quality of care for pregnancy, perinatal and newborn care at district and sub-district public health facilities in three districts of Haryana, India: An Implementation study.

<h4>Introduction</h4>Improving quality of care (QoC) for childbirth and sick newborns is critical for maternal and neonatal mortality reduction. Information on the process and impact of quality improvement at district and sub-district hospitals in India is limited. This implementation re...

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Autores principales:	Manoja Kumar Das, Narendra Kumar Arora, Suresh Kumar Dalpath, Saket Kumar, Amneet P Kumar, Abhishek Khanna, Ayushi Bhatnagar, Rajiv Bahl, Yasir Bin Nisar, Shamim Ahmad Qazi, Gulshan Kumar Arora, R K Dhankhad, Krishan Kumar, Ramesh Chander, Bhanwar Singh
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/8eae8a56adbf4169a0d305495b672044
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spelling	oai:doaj.org-article:8eae8a56adbf4169a0d305495b6720442021-12-02T20:04:53ZImproving quality of care for pregnancy, perinatal and newborn care at district and sub-district public health facilities in three districts of Haryana, India: An Implementation study.1932-620310.1371/journal.pone.0254781https://doaj.org/article/8eae8a56adbf4169a0d305495b6720442021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0254781https://doaj.org/toc/1932-6203<h4>Introduction</h4>Improving quality of care (QoC) for childbirth and sick newborns is critical for maternal and neonatal mortality reduction. Information on the process and impact of quality improvement at district and sub-district hospitals in India is limited. This implementation research was prioritized by the Haryana State (India) to improve the QoC for maternal and newborn care at the busy hospitals in districts.<h4>Methods</h4>This study at nine district and sub-district referral hospitals in three districts (Faridabad, Rewari and Jhajjar) during April 2017-March 2019 adopted pre-post, quasi-experimental study design and plan-do-study-act quality improvement method. During the six quarterly plan-do-study-act cycles, the facility and district quality improvement teams led the gap identification, solution planning and implementation with external facilitation. The external facilitators monitored and collected data on indicators related to maternal and newborn service availability, patient satisfaction, case record quality, provider's knowledge and skills during the cycles. These indicators were compared between baseline (pre-intervention) and endline (post-intervention) cycles for documenting impact.<h4>Results</h4>The interventions closed 50% of gaps identified, increased the number of deliveries (1562 to 1631 monthly), improved care of pregnant women in labour with hypertension (1.2% to 3.9%, p<0.01) and essential newborn care services at birth (achieved ≥90% at most facilities). Antenatal identification of high-risk pregnancies increased from 4.1% to 8.8% (p<0.01). Hand hygiene practices improved from 35.7% to 58.7% (p<0.01). The case record completeness improved from 66% to 87% (p<0.01). The time spent in antenatal clinics declined by 19-42 minutes (p<0.01). The pooled patient satisfaction scores improved from 82.5% to 95.5% (p<0.01). Key challenges included manpower shortage, staff transfers, leadership change and limited orientation for QoC.<h4>Conclusion</h4>This multipronged quality improvement strategy improved the maternal and newborn services, case documentation and patient satisfaction at district and sub-district hospitals. The processes and lessons learned shall be useful for replicating and scaling up.Manoja Kumar DasNarendra Kumar AroraSuresh Kumar DalpathSaket KumarAmneet P KumarAbhishek KhannaAyushi BhatnagarRajiv BahlYasir Bin NisarShamim Ahmad QaziGulshan Kumar AroraR K DhankhadKrishan KumarRamesh ChanderBhanwar SinghPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0254781 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Manoja Kumar Das Narendra Kumar Arora Suresh Kumar Dalpath Saket Kumar Amneet P Kumar Abhishek Khanna Ayushi Bhatnagar Rajiv Bahl Yasir Bin Nisar Shamim Ahmad Qazi Gulshan Kumar Arora R K Dhankhad Krishan Kumar Ramesh Chander Bhanwar Singh Improving quality of care for pregnancy, perinatal and newborn care at district and sub-district public health facilities in three districts of Haryana, India: An Implementation study.
description	<h4>Introduction</h4>Improving quality of care (QoC) for childbirth and sick newborns is critical for maternal and neonatal mortality reduction. Information on the process and impact of quality improvement at district and sub-district hospitals in India is limited. This implementation research was prioritized by the Haryana State (India) to improve the QoC for maternal and newborn care at the busy hospitals in districts.<h4>Methods</h4>This study at nine district and sub-district referral hospitals in three districts (Faridabad, Rewari and Jhajjar) during April 2017-March 2019 adopted pre-post, quasi-experimental study design and plan-do-study-act quality improvement method. During the six quarterly plan-do-study-act cycles, the facility and district quality improvement teams led the gap identification, solution planning and implementation with external facilitation. The external facilitators monitored and collected data on indicators related to maternal and newborn service availability, patient satisfaction, case record quality, provider's knowledge and skills during the cycles. These indicators were compared between baseline (pre-intervention) and endline (post-intervention) cycles for documenting impact.<h4>Results</h4>The interventions closed 50% of gaps identified, increased the number of deliveries (1562 to 1631 monthly), improved care of pregnant women in labour with hypertension (1.2% to 3.9%, p<0.01) and essential newborn care services at birth (achieved ≥90% at most facilities). Antenatal identification of high-risk pregnancies increased from 4.1% to 8.8% (p<0.01). Hand hygiene practices improved from 35.7% to 58.7% (p<0.01). The case record completeness improved from 66% to 87% (p<0.01). The time spent in antenatal clinics declined by 19-42 minutes (p<0.01). The pooled patient satisfaction scores improved from 82.5% to 95.5% (p<0.01). Key challenges included manpower shortage, staff transfers, leadership change and limited orientation for QoC.<h4>Conclusion</h4>This multipronged quality improvement strategy improved the maternal and newborn services, case documentation and patient satisfaction at district and sub-district hospitals. The processes and lessons learned shall be useful for replicating and scaling up.
format	article
author	Manoja Kumar Das Narendra Kumar Arora Suresh Kumar Dalpath Saket Kumar Amneet P Kumar Abhishek Khanna Ayushi Bhatnagar Rajiv Bahl Yasir Bin Nisar Shamim Ahmad Qazi Gulshan Kumar Arora R K Dhankhad Krishan Kumar Ramesh Chander Bhanwar Singh
author_facet	Manoja Kumar Das Narendra Kumar Arora Suresh Kumar Dalpath Saket Kumar Amneet P Kumar Abhishek Khanna Ayushi Bhatnagar Rajiv Bahl Yasir Bin Nisar Shamim Ahmad Qazi Gulshan Kumar Arora R K Dhankhad Krishan Kumar Ramesh Chander Bhanwar Singh
author_sort	Manoja Kumar Das
title	Improving quality of care for pregnancy, perinatal and newborn care at district and sub-district public health facilities in three districts of Haryana, India: An Implementation study.
title_short	Improving quality of care for pregnancy, perinatal and newborn care at district and sub-district public health facilities in three districts of Haryana, India: An Implementation study.
title_full	Improving quality of care for pregnancy, perinatal and newborn care at district and sub-district public health facilities in three districts of Haryana, India: An Implementation study.
title_fullStr	Improving quality of care for pregnancy, perinatal and newborn care at district and sub-district public health facilities in three districts of Haryana, India: An Implementation study.
title_full_unstemmed	Improving quality of care for pregnancy, perinatal and newborn care at district and sub-district public health facilities in three districts of Haryana, India: An Implementation study.
title_sort	improving quality of care for pregnancy, perinatal and newborn care at district and sub-district public health facilities in three districts of haryana, india: an implementation study.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/8eae8a56adbf4169a0d305495b672044
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Improving quality of care for pregnancy, perinatal and newborn care at district and sub-district public health facilities in three districts of Haryana, India: An Implementation study.

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