Pre-post study of an audit and feedback intervention to reduce intrapartum stillbirth in Mombasa, Kenya

肯尼亚蒙巴萨减少产时死产的审计和反馈干预的事前研究

基本信息

批准号：
10395411
负责人：
Jessica Long
金额：
$ 3.24万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-11-01 至 2022-10-07
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10395411
关键词：
Address Affect Africa South of the Sahara Area Birth Calendar Caring Cesarean section Clinic Congenital Abnormality Cost Analysis Country County Data Developed Countries Development Effectiveness of Interventions Emergency Situation Evidence based intervention Family Planning Feedback Fellowship Fetal Distress Fetal Monitoring General Hospitals Genetic Goals Grant Health Health care facility Hospitals Human immunodeficiency virus test Incidence Income Induced Labor Infant Care International Interruption Intervention Kenya Labor Onset Measures Mentorship National Institute of Child Health and Human Development Newborn Infant Outcome Perinatal Perinatal mortality demographics Perinatology Process Process Measure Public Health Public Hospitals Publishing Qualitative Methods Quality of Care Records Reporting Research Research Personnel Resource-limited setting System Time Time Series Analysis Time and Motion Studies Training Treatment Efficacy Universities Washington Woman Work World Health Writing base budget impact career career networking cost cost effective design effective intervention effectiveness evaluation efficacious intervention experience flexibility health care delivery implementation research implementation science improved intervention cost intrapartum low income country maternal morbidity microcosting mortality obstetric care perinatal morbidity prevent provider behavior response scale up secondary outcome skills stillbirth symposium tool ward

项目摘要

ABSTRACT Stillbirth disproportionately affects those in low-resource settings, with 10-fold higher stillbirth rates in low-income countries compared to high-income countries. This disparity is due in part to gaps in health care delivery; even facilities that are equipped to provide comprehensive emergency obstetric and newborn care (CEmONC) often fail to deliver care quickly and effectively. A third of intrapartum stillbirths (those occurring after the onset of labor) could be prevented through improved labor and delivery management and use of interventions that are known to be efficacious (e.g. cesarean sections). The Every Newborn Action Plan (ENAP) has set a global target stillbirth rate of 12 per 1000 births by 2030. At Coast Provincial General Hospital (CPGH), a large CEmONC facility in Mombasa, Kenya, the intrapartum stillbirth rate is substantially higher than this target, at 21.2 per 1000 births. To address this problem, the Mombasa County Ministry of Health wishes to conduct an audit and feedback quality improvement project within the Labor and Delivery Ward of CPGH. In this proposal, our objectives are to identify factors associated with stillbirth at CPGH to inform the development of this project, and to evaluate the effectiveness of this intervention in reducing intrapartum stillbirth. The aims of this proposal are: 1) to identify factors associated with intrapartum stillbirth that could be addressed by modifying provider behavior; 2) to conduct a pre-post study using interrupted time series analysis to determine if rates of stillbirth are reduced after implementation of an audit and feedback intervention; and 3) to determine the incremental cost and budget impact of the audit and feedback intervention. The proposed research will use quantitative and qualitative methods to assess change in both process indicators (e.g. time to cesarean section) and intrapartum stillbirth rates before and after the audit and feedback intervention. Demonstrating how effective the intervention is at both changing targeted provider behavior and reducing stillbirth rates is critical to determining its public health impact. Audit and feedback is a flexible approach that allows for context-specific factors to be considered and addressed. If found to be effective and low-cost, this approach could be expanded to other CEmONC facilities in sub-Saharan Africa as a cost-effective means of lowering stillbirth rates. To conduct this work, the candidate will receive training at the University of Washington, which is a world leader in implementation research. Her training plan will include field experience, coursework, supplementary training, and mentorship in implementation science, interrupted time series analysis, and cost analysis. The fellowship will also provide ample opportunities for the candidate to publish original research, present work at international conferences, develop a professional network, and gain experience with grant writing. This set of skills will put her on a path toward a career as an independent investigator.

抽象的死产对资源匮乏地区的影响尤为严重，低收入地区的死产率高出 10 倍国家与高收入国家相比。这种差异的部分原因是医疗服务提供方面的差距；甚至设施齐全，经常提供全面的紧急产科和新生儿护理 (CEmONC) 无法快速有效地提供护理。三分之一的产时死产（产程开始后发生的死产）可以通过改善分娩管理以及使用已知的干预措施来预防有效（例如剖腹产）。每个新生儿行动计划 (ENAP) 设定了全球目标到 2030 年，死产率为每 1000 名新生儿中有 12 名死产。在海岸省总医院 (CPGH)，一个大型 CEmONC 在肯尼亚蒙巴萨的设施中，产时死产率远高于这一目标，为每 1000 人 21.2 人出生。针对这一问题，蒙巴萨县卫生部希望进行审核并反馈 CPGH 产房内的质量改进项目。在本提案中，我们的目标是确定与 CPGH 死产相关的因素，为该项目的开发提供信息，并评估这种干预措施在减少产时死产方面的有效性。该提案的目的是：1）确定与产时死产相关的因素可以通过改变提供者的行为来解决； 2）到使用中断时间序列分析进行事前研究，以确定死产率是否会降低实施审计和反馈干预； 3) 确定增量成本和预算审计和反馈干预的影响。拟议的研究将使用定量和定性评估过程指标（例如剖腹产时间）和产时死产变化的方法审核和反馈干预前后的评分。展示干预措施的有效性改变目标提供者的行为和降低死产率对于确定其公共卫生至关重要影响。审计和反馈是一种灵活的方法，可以考虑特定环境因素并已解决。如果发现有效且低成本，该方法可以扩展到其他 CEmONC 设施在撒哈拉以南非洲地区作为降低死产率的具有成本效益的手段。为了开展这项工作，候选人将在华盛顿大学接受培训，该大学在实施研究方面处于世界领先地位。她培训计划将包括现场经验、课程作业、补充培训和实施指导科学、中断时间序列分析和成本分析。该奖学金还将提供充足的机会为候选人发表原创研究、在国际会议上展示工作、培养专业人才网络，并获得资助写作的经验。这套技能将使她走上职业道路独立调查员。