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Research
A Comparison of Intensive vs. Light-Touch Quality Improvement Interventions for Maternal Health in Uttar Pradesh, India
Dominic Montagu
UCSF
Corresponding Author
ORCiD: https://orcid.org/0000-0002-2477-5543
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Poor patient experiences during delivery leads to delayed presentation at facilities and contributes to poor maternal health outcomes. Person-centered maternity care (PCMC) is a key component of quality. Improving PCMC requires changing the process of care which can be complex and require significant external input, making replication and scale difficult. This study compared the effectiveness two Quality Improvement (QI) intervention phases, one Intensive, one Light-Touch.
Methods
We used a matched case-control design to compare two phases of a QI Intervention targeting PCMC, with three facilities in each. The Intensive phase was introduced into three government facilities where teams were supported to identify, design, and test potential improvements over 12 months. The Light-Touch phase was subsequently introduced in three other government facilities and changes were tracked over six months. We compared the two groups using multivariate linear regression and difference-in-difference models to assess changes in PCMC outcome.
Results
Both Intensive and Light-Touch arms demonstrated large improvements in PCMC. On a scale from 0 to 100, Intensive facilities increased in PCMC scores from 85.02 to 97.13, while Light-Touch facilities increased from 63.42 to 87.47. For both there was a ‘halo’ effect, with a similar improvement recorded for the specific improvement activities focused on, as w ell as aspects of PCMC not directly addressed.
Conclusions
This study demonstrated that a short, inexpensive, light-touch and directive intervention can change staff practices and significantly improve the experiences of women during childbirth. It also shows that improvements in a few areas of provider-patient interaction have a ‘halo’ effect, changing many other aspects of patient-provider interaction at the same time.
Trial Registration
QI Phase 1 - NCT04208867. Retrospectively registered. December 19th, 2019. link to the registration:https://clinicaltrials.gov/ct2/show/NCT04208867?term=NCT04208867&draw=2&rank=1
QI Phase 2 – NCT04208841. Retrospectively registered. December 23, 2019. link to the registration:https://clinicaltrials.gov/ct2/show/NCT04208841?term=NCT04208841&draw=2&rank=1
CONTRIBUTIONS TO THE LITERATURE 98 words
· Medical practioners’ treatment of patients are influenced by institutional norms and difficult to change.
· Team-based initiatives which actively engage staff have been effective in wealthy countries but are not common in middle-income settings, and have not been applied to person-centered aspects of care.
· We found that team-based quality improvement efforts were effective in India at changing patient experience. Once change-practices were identified, these practices were introduced to new facilities with low-intesity support and proved equally effective at improving care.
· These findings add to the limited evidence on team-based quality improvement, and provide evidence of effective scaleable implementation opportunities.
Keywords
Quality Improvement, Person-Centered Care, Maternal Health
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Research
A Comparison of Intensive vs. Light-Touch Quality Improvement Interventions for Maternal Health in Uttar Pradesh, India
Dominic Montagu
UCSF
Corresponding Author
ORCiD: https://orcid.org/0000-0002-2477-5543
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 28 May, 2020
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Environmental Policy
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Poor patient experiences during delivery leads to delayed presentation at facilities and contributes to poor maternal health outcomes. Person-centered maternity care (PCMC) is a key component of quality. Improving PCMC requires changing the process of care which can be complex and require significant external input, making replication and scale difficult. This study compared the effectiveness two Quality Improvement (QI) intervention phases, one Intensive, one Light-Touch.
Methods
We used a matched case-control design to compare two phases of a QI Intervention targeting PCMC, with three facilities in each. The Intensive phase was introduced into three government facilities where teams were supported to identify, design, and test potential improvements over 12 months. The Light-Touch phase was subsequently introduced in three other government facilities and changes were tracked over six months. We compared the two groups using multivariate linear regression and difference-in-difference models to assess changes in PCMC outcome.
Results
Both Intensive and Light-Touch arms demonstrated large improvements in PCMC. On a scale from 0 to 100, Intensive facilities increased in PCMC scores from 85.02 to 97.13, while Light-Touch facilities increased from 63.42 to 87.47. For both there was a ‘halo’ effect, with a similar improvement recorded for the specific improvement activities focused on, as w ell as aspects of PCMC not directly addressed.
Conclusions
This study demonstrated that a short, inexpensive, light-touch and directive intervention can change staff practices and significantly improve the experiences of women during childbirth. It also shows that improvements in a few areas of provider-patient interaction have a ‘halo’ effect, changing many other aspects of patient-provider interaction at the same time.
Trial Registration
QI Phase 1 - NCT04208867. Retrospectively registered. December 19th, 2019. link to the registration:https://clinicaltrials.gov/ct2/show/NCT04208867?term=NCT04208867&draw=2&rank=1
QI Phase 2 – NCT04208841. Retrospectively registered. December 23, 2019. link to the registration:https://clinicaltrials.gov/ct2/show/NCT04208841?term=NCT04208841&draw=2&rank=1
CONTRIBUTIONS TO THE LITERATURE 98 words
· Medical practioners’ treatment of patients are influenced by institutional norms and difficult to change.
· Team-based initiatives which actively engage staff have been effective in wealthy countries but are not common in middle-income settings, and have not been applied to person-centered aspects of care.
· We found that team-based quality improvement efforts were effective in India at changing patient experience. Once change-practices were identified, these practices were introduced to new facilities with low-intesity support and proved equally effective at improving care.
· These findings add to the limited evidence on team-based quality improvement, and provide evidence of effective scaleable implementation opportunities.
Figure 1
Figure 2