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1.
JAMA ; 323(4): 352-366, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31990319

RESUMO

Importance: The tort liability system is intended to serve 3 functions: compensate patients who sustain injury from negligence, provide corrective justice, and deter negligence. Deterrence, in theory, occurs because clinicians know that they may experience adverse consequences if they negligently injure patients. Objective: To review empirical findings regarding the association between malpractice liability risk (ie, the extent to which clinicians face the threat of being sued and having to pay damages) and health care quality and safety. Data Sources and Study Selection: Systematic search of multiple databases for studies published between January 1, 1990, and November 25, 2019, examining the relationship between malpractice liability risk measures and health outcomes or structural and process indicators of health care quality. Data Extraction and Synthesis: Information on the exposure and outcome measures, results, and acknowledged limitations was extracted by 2 reviewers. Meta-analytic pooling was not possible due to variations in study designs; therefore, studies were summarized descriptively and assessed qualitatively. Main Outcomes and Measures: Associations between malpractice risk measures and health care quality and safety outcomes. Exposure measures included physicians' malpractice insurance premiums, state tort reforms, frequency of paid claims, average claim payment, physicians' claims history, total malpractice payments, jury awards, the presence of an immunity from malpractice liability, the Centers for Medicare & Medicaid Services' Medicare malpractice geographic practice cost index, and composite measures combining these measures. Outcome measures included patient mortality; hospital readmissions, avoidable admissions, and prolonged length of stay; receipt of cancer screening; Agency for Healthcare Research and Quality patient safety indicators and other measures of adverse events; measures of hospital and nursing home quality; and patient satisfaction. Results: Thirty-seven studies were included; 28 examined hospital care only and 16 focused on obstetrical care. Among obstetrical care studies, 9 found no significant association between liability risk and outcomes (such as Apgar score and birth injuries) and 7 found limited evidence for an association. Among 20 studies of patient mortality in nonobstetrical care settings, 15 found no evidence of an association with liability risk and 5 found limited evidence. Among 7 studies that examined hospital readmissions and avoidable initial hospitalizations, none found evidence of an association between liability risk and outcomes. Among 12 studies of other measures (eg, patient safety indicators, process-of-care quality measures, patient satisfaction), 7 found no association between liability risk and these outcomes and 5 identified significant associations in some analyses. Conclusions and Relevance: In this systematic review, most studies found no association between measures of malpractice liability risk and health care quality and outcomes. Although gaps in the evidence remain, the available findings suggested that greater tort liability, at least in its current form, was not associated with improved quality of care.


Assuntos
Responsabilidade Legal , Imperícia/legislação & jurisprudência , Qualidade da Assistência à Saúde , Humanos , Seguro de Responsabilidade Civil/economia , Imperícia/economia , Imperícia/estatística & dados numéricos , Obstetrícia/normas , Complicações Pós-Operatórias
4.
Rev Med Suisse ; 15(668): 1920-1924, 2019 Oct 23.
Artigo em Francês | MEDLINE | ID: mdl-31643152

RESUMO

Both cesarean surgery and induction of labor have become common procedures performed in all labor wards in an attempt to reduce adverse obstetrical and neonatal outcomes. Thus, recent evidence, led by the ARRIVE Trial, demonstrated that elective induction at 39 weeks reduced the rates of cesarean deliveries and of hypertensive disorders of pregnancy. However, some concerns must be addressed, as the benefits of universal policies have to be outweighed with the current circumstances of implementation, the economic impact, the number of procedures needed to effectively reduce complications, and, above all, women's perception towards this approach. Therefore, it would be interesting to explore individualization strategies, instead of general recommendations, to offer personalized care.


Assuntos
Cesárea , Ensaios Clínicos como Assunto , Trabalho de Parto Induzido , Obstetrícia/métodos , Obstetrícia/normas , Cesárea/psicologia , Cesárea/normas , Procedimentos Cirúrgicos Eletivos/psicologia , Procedimentos Cirúrgicos Eletivos/normas , Feminino , Humanos , Trabalho de Parto Induzido/psicologia , Trabalho de Parto Induzido/normas , Gravidez , Resultado da Gravidez
5.
Rev Prat ; 69(4): 417-422, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-31626499

RESUMO

Menometrorrhagia is a frequent bleeding symptom in young women, and may be related to an inherited bleeding disorder. If there is no gynecological etiology, hemostasis tests are required. The early medical management of these teenage girls is important, especially when a bleeding disorder is known. The bleeding risk of the first periods may then be anticipated. Afterwards, the objective of the treatment is to keep the bleeding symptoms under control: anti-fibrinolytic treatment, specific replacement therapy for bleeding disorder and hormonal treatment. This management requires a multidisciplinary medical team, mainly hematologist and gynecologist, all along the genital lifespan, from the first periods to the desire for pregnancy.


Assuntos
Transtornos Herdados da Coagulação Sanguínea , Menorragia , Adolescente , Transtornos Herdados da Coagulação Sanguínea/terapia , Feminino , Ginecologia/normas , Hematologia/normas , Humanos , Menorragia/terapia , Menstruação/fisiologia , Obstetrícia/normas , Gravidez
6.
PLoS Med ; 16(10): e1002923, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31584941

RESUMO

BACKGROUND: Preterm infants are a group at high risk of having experienced placental insufficiency. It is unclear which growth charts perform best in identifying infants at increased risk of stillbirth and other adverse perinatal outcomes. We compared 2 birthweight charts (population centiles and INTERGROWTH-21st birthweight centiles) and 3 fetal growth charts (INTERGROWTH-21st fetal growth charts, World Health Organization fetal growth charts, and Gestation Related Optimal Weight [GROW] customised growth charts) to identify which chart performed best in identifying infants at increased risk of adverse perinatal outcome in a preterm population. METHODS AND FINDINGS: We conducted a retrospective cohort study of all preterm infants born at 24.0 to 36.9 weeks gestation in Victoria, Australia, from 2005 to 2015 (28,968 records available for analysis). All above growth charts were applied to the population. Proportions classified as <5th centile and <10th centile by each chart were compared, as were proportions of stillborn infants considered small for gestational age (SGA, <10th centile) by each chart. We then compared the relative performance of non-overlapping SGA cohorts by each chart to our low-risk reference population (infants born appropriate size for gestational age [>10th and <90th centile] by all intrauterine charts [AGAall]) for the following perinatal outcomes: stillbirth, perinatal mortality (stillbirth or neonatal death), Apgar <4 or <7 at 5 minutes, neonatal intensive care unit admissions, suspicion of poor fetal growth leading to expedited delivery, and cesarean section. All intrauterine charts classified a greater proportion of infants as <5th or <10th centile than birthweight charts. The magnitude of the difference between birthweight and fetal charts was greater at more preterm gestations. Of the fetal charts, GROW customised charts classified the greatest number of infants as SGA (22.3%) and the greatest number of stillborn infants as SGA (57%). INTERGROWTH classified almost no additional infants as SGA that were not already considered SGA on GROW or WHO charts; however, those infants classified as SGA by INTERGROWTH had the greatest risk of both stillbirth and total perinatal mortality. GROW customised charts classified a larger proportion of infants as SGA, and these infants were still at increased risk of mortality and adverse perinatal outcomes compared to the AGAall population. Consistent with similar studies in this field, our study was limited in comparing growth charts by the degree of overlap, with many infants classified as SGA by multiple charts. We attempted to overcome this by examining and comparing sub-populations classified as SGA by only 1 growth chart. CONCLUSIONS: In this study, fetal charts classified greater proportions of preterm and stillborn infants as SGA, which more accurately reflected true fetal growth restriction. Of the intrauterine charts, INTERGROWTH classified the smallest number of preterm infants as SGA, although it identified a particularly high-risk cohort, and GROW customised charts classified the greatest number at increased risk of perinatal mortality.


Assuntos
Gráficos de Crescimento , Recém-Nascido Prematuro/crescimento & desenvolvimento , Recém-Nascido Pequeno para a Idade Gestacional/crescimento & desenvolvimento , Neonatologia/normas , Obstetrícia/normas , Adulto , Peso ao Nascer , Feminino , Desenvolvimento Fetal , Humanos , Recém-Nascido , Idade Materna , Gravidez , Resultado da Gravidez , Nascimento Prematuro , Estudos Retrospectivos , Risco , Natimorto , Vitória/epidemiologia , Adulto Jovem
7.
In Vivo ; 33(5): 1547-1551, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31471403

RESUMO

An increasing trend in funding towards artificial intelligence (AI) research in medicine has re-animated huge expectations for future applications. Obstetrics and gynaecology remain highly litigious specialities, accounting for a large proportion of indemnity payments due to poor outcomes. Several challenges have to be faced in order to improve current clinical practice in both obstetrics and gynaecology. For instance, a complete understanding of fetal physiology and establishing accurately predictive antepartum and intrapartum monitoring are yet to be achieved. In gynaecology, the complexity of molecular biology results in a lack of understanding of gynaecological cancer, which also contributes to poor outcomes. In this review, we aim to describe some important applications of AI in obstetrics and gynaecology. We also discuss whether AI can lead to a deeper understanding of pathophysiological concepts in obstetrics and gynaecology, allowing delineation of some grey zones, leading to improved healthcare provision. We conclude that AI can be used as a promising tool in obstetrics and gynaecology, as an approach to resolve several longstanding challenges; AI may also be a means to augment knowledge and assist clinicians in decision-making in a variety of areas in obstetrics and gynaecology.


Assuntos
Inteligência Artificial , Ginecologia , Informática Médica , Obstetrícia , Feminino , Ginecologia/métodos , Ginecologia/normas , Ginecologia/tendências , Humanos , Informática Médica/métodos , Informática Médica/normas , Informática Médica/tendências , Obstetrícia/métodos , Obstetrícia/normas , Obstetrícia/tendências , Medicina de Precisão/métodos , Medicina de Precisão/normas
8.
BMC Health Serv Res ; 19(1): 655, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31500636

RESUMO

BACKGROUND: Uganda, a low resource country, implemented the skilled attendance at birth strategy, to meet a key target of the 5th Millenium Development Goal (MDG), 75% reduction in maternal mortality ratio. Maternal mortality rates remained high, despite the improvement in facility delivery rates. In this paper, we analyse the strategies implemented and bottlenecks experienced as Uganda's skilled birth attendance policy was rolled out. These experiences provide important lessons for decision makers as they implement policies to further improve maternity care. METHODS: This is a case study of the implementation process, involving a document review and in-depth interviews among key informants selected from the Ministry of Health, Professional Organisations, Ugandan Parliament, the Health Service Commission, the private not-for-profit sector, non-government organisations, and District Health Officers. The Walt and Gilson health policy triangle guided data collection and analysis. RESULTS: The skilled birth attendance policy was an important priority on Uganda's maternal health agenda and received strong political commitment, and support from development partners and national stakeholders. Considerable effort was devoted to implementation of this policy through strategies to increase the availability of skilled health workers for instance through expanded midwifery training, and creation of the comprehensive nurse midwife cadre. In addition, access to emergency obstetric care improved to some extent as the physical infrastructure expanded, and distribution of medicines and supplies improved. However, health worker recruitment was slow in part due to the restrictive staff norms that were remnants of previous policies. Despite considerable resources allocated to creating the comprehensive nurse midwife cadre, this resulted in nurses that lacked midwifery skills, while the training of specialised midwives reduced. The rate of expansion of the physical infrastructure outpaced the available human resources, equipment, blood infrastructure, and several health facilities were not fully functional. CONCLUSION: Uganda's skilled birth attendance policy aimed to increase access to obstetric care, but recruitment of human resources, and infrastructural capacity to provide good quality care remain a challenge. This study highlights the complex issues and unexpected consequences of policy implementation. Further evaluation of this policy is needed as decision-makers develop strategies to improve access to skilled care at birth.


Assuntos
Política de Saúde , Acesso aos Serviços de Saúde/normas , Serviços de Saúde Materna/organização & administração , Tocologia/organização & administração , Enfermeiras Obstétricas/provisão & distribução , Parto Obstétrico/normas , Parto Obstétrico/estatística & dados numéricos , Feminino , Instalações de Saúde/normas , Acesso aos Serviços de Saúde/organização & administração , Humanos , Serviços de Saúde Materna/normas , Mortalidade Materna , Tocologia/normas , Tocologia/estatística & dados numéricos , Enfermeiras Obstétricas/organização & administração , Enfermeiras Obstétricas/normas , Obstetrícia/normas , Formulação de Políticas , Gravidez , Qualidade da Assistência à Saúde , Uganda
9.
Obstet Gynecol Surv ; 74(8): 481-489, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31418450

RESUMO

Importance: Physical activity during pregnancy can offer many maternal and fetal health benefits. Objective: The aim was to summarize American, Canadian, and international recommendations published recently on physical activity during pregnancy to aid health care providers in their delivery of advice on the topic. Evidence Acquisition: A descriptive review of 3 national guidelines and 1 international guideline on physical activity during pregnancy was conducted. The guidelines included the 2019 Canadian recommendations, the 2018 United States' Physical Activity Guidelines for Americans (second edition), the 2015 (reaffirmed in 2017) American College of Obstetrics and Gynecology guideline, and the 2016-2018 International Olympic Committee recommendations for recreational and elite athletes. Results: For apparently healthy women, under the guidance of their health care provider, moderate-intensity physical activity using both aerobic and muscle conditioning activities is recommended. The guidelines recommended at least 150 min/wk spread throughout the week (Canada, United States) or at least 20 to 30 min/d (American College of Obstetrics and Gynecology). Conclusions and Relevance: This summary of 4 recent guidelines can facilitate use of updated recommendations by health care providers regarding physical activity during pregnancy. More detailed evidence-based guidelines on physical activity during postpartum are needed.


Assuntos
Terapia por Exercício/normas , Exercício , Obstetrícia/normas , Guias de Prática Clínica como Assunto , Cuidado Pré-Natal/normas , Canadá , Feminino , Humanos , Gravidez , Estados Unidos
10.
BMC Pregnancy Childbirth ; 19(1): 307, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31443691

RESUMO

BACKGROUND: Healthcare providers are the vital link between evidence-based policies and women receiving high quality maternity care. Explanations for suboptimal care often include poor working conditions for staff and a lack of essential supplies. Other explanations suggest that doctors, midwives and care assistants might lack essential skills or be unaware of the rights of the women for whom they care. This ethnography examined the everyday lives of maternal healthcare providers working in a tertiary maternity hospital in Kabul, Afghanistan between 2010 and 2012. The aim was to understand their notions of care, varying levels of commitment, and the obstacles and dilemmas that affected standards. METHODS: The culture of care was explored through six weeks of observation, 41 background interviews, 23 semi-structured interviews with doctors, midwives and care assistants. Focus groups were held with two diverse groups of women in community settings to understand their experiences and desires regarding care in maternity hospitals. Data were analysed thematically. RESULTS: Women related many instances of neglect, verbal abuse and demands for bribes from staff. Doctors and midwives concurred that they did not provide care as they had been taught and blamed the workload, lack of a shift system, insufficient supplies and inadequate support from management. Closer inspection revealed a complex reality where care was impeded by low levels of supplies and medicines but theft reduced them further; where staff were unfairly blamed by management but others flouted rules with impunity; and where motivated staff tried hard to work well but, when overwhelmed with the workload, admitted that they lost patience and shouted at women in childbirth. In addition there were extreme examples of both abusive and vulnerable staff. CONCLUSIONS: Providing respectful quality maternity care for women in Afghanistan requires multifaceted initiatives because the factors leading to suboptimal care or mistreatment are complex and interrelated. Standards need enforcing and abusive practices confronting to provide a supportive, facilitating environment for both staff and childbearing women. Polarized perspectives such as 'villain' or 'victim' are unhelpful as they exclude the complex realities of human behaviour and consequently limit the scope of problem solving.


Assuntos
Atitude do Pessoal de Saúde , Assistência à Saúde/normas , Pessoal de Saúde/psicologia , Serviços de Saúde Materna/normas , Relações Profissional-Paciente , Adulto , Afeganistão , Antropologia Cultural , Assistência à Saúde/métodos , Parto Obstétrico/psicologia , Feminino , Grupos Focais , Pessoal de Saúde/normas , Maternidades/normas , Humanos , Tocologia/normas , Obstetrícia/normas , Parto/psicologia , Gravidez , Pesquisa Qualitativa , Respeito , Carga de Trabalho/psicologia , Adulto Jovem
13.
Rev Epidemiol Sante Publique ; 67(4): 213-221, 2019 Jul.
Artigo em Francês | MEDLINE | ID: mdl-31196581

RESUMO

BACKGROUND: Since 2008, in France, hospital funding is determined by the nature of activities provided (activity-based funding). Quality control of hospital activity coding is essential to optimize hospital remuneration. There is a need for reliable tools to allocate human resources wisely in order to improve these controls. METHODS: The main objective of this study was to identify the determinants of time needed by medical information technicians to control hospital activity coding in a Regional Hospital Center. From March 2016 to the beginning of January 2017, medical information technicians reported the time they spent on each quality control, and the time they needed when they had to code the entire stay. Multiple linear regressions were performed to identify the determinants of quality control or coding duration. A split sample validation was used: model was created on one half of the sample and validated on the remaining half. RESULTS: Among the controls, 5431 were included in the analysis of determinants of control duration (2715 kept aside for model validation). Seven determinants have been identified (stay duration, level of complexity, month of control, type of control, medical information technician, rank of classing information, and major diagnostic category). The correlation coefficient between predicted and real control duration was 0.71 (P<10-4); 808 stays were included in the analysis of determinants of coding duration (404 kept aside for model validation). Two determinants have been identified. The correlation coefficient, between predicted and real coding duration, was 0.47 (P<10-3). We performed the same multiple regression, on 2017 activity data, to estimate the weight of each hospital activity pole, regarding quality control of hospital activity coding. CONCLUSION: We succeeded in modeling time needed for quality control of hospital stays. These results helped to estimate human resources required for quality control of each hospital pole. Nevertheless, the second analysis did not give satisfactory results: we failed in modeling time needed to code hospital stays.


Assuntos
Codificação Clínica , Medicina Geral , Cirurgia Geral , Tempo de Internação , Informática Médica , Obstetrícia , Controle de Qualidade , Estudos de Casos e Controles , Codificação Clínica/organização & administração , Codificação Clínica/normas , Grupos Diagnósticos Relacionados/organização & administração , Grupos Diagnósticos Relacionados/normas , Registros Eletrônicos de Saúde/organização & administração , Registros Eletrônicos de Saúde/normas , Honorários Médicos , Feminino , França , Medicina Geral/organização & administração , Medicina Geral/normas , Cirurgia Geral/organização & administração , Cirurgia Geral/normas , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Informática Médica/métodos , Informática Médica/organização & administração , Informática Médica/normas , Obstetrícia/organização & administração , Obstetrícia/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Qualidade da Assistência à Saúde , Programas Médicos Regionais/organização & administração , Programas Médicos Regionais/normas , Fatores de Tempo , Carga de Trabalho
14.
BMC Pregnancy Childbirth ; 19(1): 181, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31117985

RESUMO

Management of late-term pregnancy in midwifery- and obstetrician-led care. BACKGROUND: Since there is no consensus regarding the optimal management in late-term pregnancies (≥41.0 weeks), we explored the variety of management strategies in late-term pregnancy in the Netherlands to identify the magnitude of this variety and the attitude towards late-term pregnancy. METHODS: Two nationwide surveys amongst all midwifery practices (midwifery-led care) and all hospitals with an obstetric unit (obstetrician-led care) were performed with questions on timing, frequency and content of consultations/surveillance in late-term pregnancy and on timing of induction. Propositions about late-term pregnancy were assessed using Likert scale questions. RESULTS: The response rate was 40% (203/511) in midwifery-led care and 92% (80/87) in obstetrician-led care. All obstetric units made regional protocols with their collaborating midwifery practices about management in late-term pregnancy. Most midwifery-led care practices (93%) refer low-risk women at least once for consultation in obstetrician-led care in late-term pregnancy. The content of consultations varies among hospitals. Membrane sweeping is performed more in midwifery-led care compared to obstetrician-led care (90% vs 31%, p < 0.001). Consultation at 41 weeks should be standard care according to 47% of midwifery-led care practices and 83% of obstetrician-led care units (p < 0.001). Induction of labour at 41.0 weeks is offered less often to women in midwifery-led care in comparison to obstetrician-led care (3% vs 21%, p < 0.001). CONCLUSIONS: Substantial practice variation exists within and between midwifery-and obstetrician-led care in the Netherlands regarding timing, frequency and content of antenatal monitoring in late-term pregnancy and timing of labour induction. An evidence based interdisciplinary guideline will contribute to a higher level of uniformity in the management in late- term pregnancies.


Assuntos
Tocologia/métodos , Enfermeiras Obstétricas/psicologia , Obstetrícia/métodos , Médicos/psicologia , Gravidez Prolongada/psicologia , Adulto , Atitude do Pessoal de Saúde , Parto Obstétrico/métodos , Parto Obstétrico/psicologia , Feminino , Humanos , Tocologia/normas , Países Baixos , Obstetrícia/normas , Gravidez , Gravidez Prolongada/terapia
16.
BJOG ; 126(12): 1437-1444, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31131503

RESUMO

OBJECTIVE: To validate the NHSLA maternity claims taxonomy at the level of a single maternity service and assess its ability to direct quality improvement. DESIGN: Qualitative descriptive study. SETTING: Medico-legal claims between 1 January 2000 and 31 December 2016 from a maternity service in metropolitan Melbourne, Australia. POPULATION: All obstetric claims and incident notifications occurring within the date range were included for analysis. METHODS: De-identified claims and notifications data were derived from the files of the insurer of Victorian public health services. Data included claim date, incident date and summary, and claim cost. All reported issues were coded using the NHSLA taxonomy and the lead issue identified. MAIN OUTCOME MEASURES: Rate of claims and notifications, relative frequency of issues, a revised taxonomy. RESULTS: A combined total of 265 claims and incidents were reported during the 6 years. Of these 59 were excluded, leaving 198 medico-legal events for analysis (1.66 events/1000 births). The costs for all claims was $46.7 million. The most common claim issues were related to management of labour (n = 63, $17.7 million), cardiotocographic interpretation (n = 43, $24.4 million), and stillbirth (n = 35, $656,750). The original NHSLA classification was not sufficiently detailed to inform care improvement programmes. A revised taxonomy and coding flowchart is presented. CONCLUSIONS: Systematic analysis of obstetric medico-legal claims data can potentially be used to inform quality and safety improvement. TWEETABLE ABSTRACT: New taxonomy to target health improvement from maternity claims based on NHSLA Ten Years of Maternity Claims.


Assuntos
Benchmarking , Imperícia/legislação & jurisprudência , Obstetrícia/normas , Feminino , Humanos , Revisão da Utilização de Seguros , Serviços de Saúde Materna/legislação & jurisprudência , Serviços de Saúde Materna/normas , Obstetrícia/legislação & jurisprudência , Gravidez , Melhoria de Qualidade , Medicina Estatal , Reino Unido
17.
Obstet Gynecol ; 133(6): 1081-1083, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31135720

RESUMO

Peer review is the major method used by the scientific community to evaluate manuscripts and decide what is suitable for publication. However, this process in its current design is not bulletproof and is prone to reviewer and editorial bias. Its lack of objectivity and transparency raise concerns that manuscripts might be judged based on interests irrelevant to the content itself and not on merit alone. This commentary reviews some of the most common biases that could potentially affect objective evaluation of a manuscript and proposes alternatives to the current single-blind peer review process that is being used by most scientific journals, including Obstetrics & Gynecology. By rethinking and tackling the shortcomings of the current methodology for peer review, we hope to create a discussion that will eventually lead to improving research and, ultimately, patient care.


Assuntos
Ginecologia/normas , Medicina/normas , Obstetrícia/normas , Revisão da Pesquisa por Pares/métodos , Humanos , Fator de Impacto de Revistas , Variações Dependentes do Observador
18.
BMC Pregnancy Childbirth ; 19(1): 155, 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060519

RESUMO

BACKGROUND: Globally, an increasing number of women give birth in a healthcare facility. Improvement in the quality of care is crucial if preventable maternal mortality and morbidity are to be reduced. A Patient Reported Outcome Measure (PROM) can be used to measure quality of care and provide new information on the impact that treatment or interventions have on patient's self-assessed health and health-related quality of life. We conducted a systematic review to identify which condition-specific PROMs are currently available for use in pregnancy and childbirth, and to evaluate whether these could potentially be used to assess the quality of care provided for women using maternity services. METHODS: We searched for articles relating to the use of PROMs related to care during pregnancy, childbirth, the postnatal period and women's health more generally using PsycINFO, CINAHL, Medline and Web of Science databases as well as "grey literature", with no date limit. Any PROM identified was reviewed with regards to development, use, and potential applicability to assess quality of maternity care provision. A narrative synthesis was used to summarise findings. RESULTS: Six papers were identified; two related to aspects of pregnancy (hyperemesis gravidarum and gestational diabetes), and four related to childbirth and the postnatal period (obstetric haemorrhage and postnatal depression). Within these papers, a total of 14 different tools were identified, which assessed a variety of aspects of physical, psychological and social health, or were generic tools, not specific to childbirth. One PROM addressed childbirth generally, however, it did not ask for or provide specific outcome measures but required women to identify and then assess what they considered the most important areas in their life affected by childbirth. CONCLUSIONS: To date, there is no PROM agreed which would be suitable as patient reported outcome measure for the assessment of the quality of care women receive during pregnancy or after childbirth. However, there are a variety of available assessment tools which could potentially be helpful in developing new and existing PROMs for maternity care.


Assuntos
Instalações de Saúde/normas , Serviços de Saúde Materna/normas , Obstetrícia/normas , Medidas de Resultados Relatados pelo Paciente , Qualidade da Assistência à Saúde/normas , Adulto , Parto Obstétrico/normas , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Qualidade de Vida
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