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Measuring Performance of a Continuous Quality Improvement Program designed to reduce Maternal Mortality in a Regional Referral Institution in Ghana.
Abstract Number: BP 4
Abstract Type: Original Research
Background: Quality improvement (QI) programs are becoming increasingly common within health care settings, including maternity services. Despite descriptions of QI programs, few provide solid evidence of benefit, especially in resource poor settings.1-3 From 2007-2011, Kybele and the Ghana Health service partnered to reduce maternal and perinatal mortality in a large regional hospital. A continuous QI program was developed based on analysis of patient care processes. A variety of improvement activities were grouped into personnel, quality-communication and system-management based “bundles”.4 The aim of this study was to measure the performance of the QI program and to determine which activities were most important in improving operational capacity and health outcomes.
Materials and Methods: Ninety-seven improvement activities were stratified into the three bundles (personnel 27 activities; quality-communication 34 activities; system-management 36 activities). Implementation for each activity was scored tri-annually for 5 yrs by Kybele-GHS representatives as 0% (no implementation), 25% (minimal), 50% (moderate), 75% (majority), 100% (full implementation). Mean implementation scores and risk-adjusted maternal mortality ratios were calculated and included in a linear regression analysis to determine which factors were associated with improvements.
Results: At program end, 27 activities were fully implemented, 64 were partially implemented and 6 were not implemented. The average overall implementation rate was 72%; the average implementation rate for each bundle was: personnel 71%, quality-communication 70%, system-management 75%. Despite a 55% increase in patient admission and a four-fold increase in high risk cases, stillbirth was reduced by 52% and the maternal mortality ratio (MMR) was reduced by 23%. Case fatality rates for hemorrhage and hypertensive disorders were reduced by 89% and 65%, respectively, and an estimated 224 maternal deaths were averted (Table). In the regression analysis, personnel (p<0.05) and quality-communication (p<0.05) activity bundles were associated with the number of maternal deaths averted.
Conclusion: Maternal and perinatal mortality can be reduced in low resource settings. Quality improvement efforts are urgently needed to strengthen healthcare delivery.
Reference: 1)Br Med J 2008;336(7659):1491–4 2)Jt Comm J Qual Saf 2003;29(2):85–93 3)Int J Qual Hlth Care 2010;22(4):237–43 4)Int J Gynecol Obstet 2012;116:17-21