Using audit to enhance quality of maternity care in resource limited countries lessons learnt from rural Tanzania 英文参考文献.docVIP

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Using audit to enhance quality of maternity care in resource limited countries lessons learnt from rural Tanzania 英文参考文献.doc

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Using audit to enhance quality of maternity care in resource limited countries lessons learnt from rural Tanzania 英文参考文献

Nyamtemaetal.BMCPregnancyandChildbirth2011,11:94 /1471-2393/11/94 RESEARCH ARTICLE OpenAccess Usingaudittoenhancequalityofmaternitycare inresourcelimitedcountries:lessonslearntfrom ruralTanzania AngeloSNyamtema1*,AliseBartschdeJong2,DavidPUrassa3andJosvanRoosmalen2,4 Abstract Background:Althoughclinicalauditisanimportantinstrumentforqualitycareimprovement,theconcepthasnot yetbeenadequatelytakenonboardinruralsettingsinmostresourcelimitedcountrieswheretheproblemof maternalmortalityisimmense.MaternalmortalityandmorbidityauditwasestablishedatSaintFrancisDesignated DistrictHospital(SFDDH)inruralTanzaniainordertogenerateinformationuponwhichtobaseinterventions. Methods:Methodsareinformedbytheprinciplesofoperationsresearch.Anauditsystemwasestablished,all patientsfulfillingtheinclusioncriteriaformaternalmortalityandseveremorbiditywerereviewedandselected caseswereauditedfromOctober2008toJuly2010.Thecausesandunderlyingfactorswereidentifiedand strategicactionplansforimprovementweredevelopedandimplemented. Results:Therewere6572deliveriesand363severematernalmorbiditiesofwhich36womendiedmaking institutionalcasefatalityrateof10%.Ofallmorbidities341(94%)hadatleastoneareaofsubstandardcare. Patients,healthworkersandadministrationrelatedsubstandardcarefactorswereidentifiedin50%-61%of womenwithseveremorbidities.Improvingresponsivenesstoobstetricemergencies,capacitybuildingofthe workforceforhealthcare,referralsystemimprovementandupgradingofhealthcentreslocatedinhardtoreach areastoprovidecomprehensiveemergencyobstetriccare(CEmOC)wereproposedandimplementedasaresult ofaudit. Conclusions:Ourfindingsindicatethatauditcanbeimplementedinruralresourcelimitedsettingsandsuggest thatthevastmajorityofmaternalmortalitiesandseveremorbiditiescanbeavertedevenwhereresourcesare limitedifstrategicinterventionsareimplemented. Background substandardcareandhowtheycanbeaverted[5-7].Sub- Everyyearworldwidethereare358,000maternaldeaths; standard care could berelated tothe patient: where a 99%ofthesetakepl