Evaluation of a quality improvement intervention for labour and birth care in Brazilian private hospitals: a protocol

Abstract

BackgroundIn Brazilian private hospitals, caesarean section (CS) is almost universal (88%) and is integrated into the model of birth care. A quality improvement intervention, “Adequate Birth” (PPA), based on four driving components (governance, participation of women and families, reorganisation of care, and monitoring), has been implemented to help 23 hospitals reduce their CS rate. This is a protocol designed to evaluate the implementation of PPA and its effectiveness at reducing CS as a primary outcome of birth care.MethodsCase study of PPA intervention conducted in 2017/2018. We integrated quantitative and qualitative methods into data collection and analysis. For the quantitative stage, we selected a convenient sample of twelve hospitals. In each of these hospitals, we included 400 women. This resulted in a total sample of 4800 women. We used this sample to detect a 2.5% reduction in CS rate. We interviewed managers and puerperal women, and extracted data from hospital records. In the qualitative stage, we evaluated a subsample of eight hospitals by means of systematic observation and semi-structured interviews with managers, health professionals and women. We used specific forms for each of the four PPA driving components. Forms for managers and professionals addressed the decision-making process, implemented strategies, participatory process in strategy design, and healthcare practice. Forms for women and neonatal care addressed socio-economic, demographic and health condition; prenatal and birth care; tour of the hospital before delivery; labour expectation vs. real experience; and satisfaction with care received. We will estimate the degree of implementation of PPA strategies related to two of the four driving components: “participation of women and families” and “reorganisation of care”. We will then assess its effect on CS rate and secondary outcomes for each of the twelve selected hospitals, and for the total sample. To allow for clinical, socio-demographic and obstetric characteristics in women, we will conduct multivariate analysis. Additionally, we will evaluate the influence of internal context variables (the PPA driving components “governance” and “monitoring”) on the degree of implementation of the components “participation of women and families” and “reorganisation of care”, by means of thematic content analysis. This analysis will include both quantitative and qualitative data.DiscussionThe effectiveness of quality improvement interventions that reduce CS rates requires examination. This study will identify strategies that could promote healthier births.Electronic supplementary materialThe online version of this article (10.1186/s12978-018-0636-y) contains supplementary material, which is available to authorized users.

Avanços na assistência ao parto no Brasil: resultados preliminares de dois estudos avaliativos

“…The data were collected from a convenience sample, composed of 12 of 35 hospitals that underwent Adequate Birth intervention since its inception in 2015. We selected these 12 hospitals based on the following criteria: regional representation (nine hospitals from the Southeast, two from the South and one from the Northeast), hospital type (weather it belongs or not to a health insurance plan provider) and Adequate Birth performance (reduction of caesarean section rates), according to information provided by the monitoring team 12 . Approximately 400 puerperal women were interviewed in each hospital, totalling 4,798 interviews.…”

Cost-effectiveness analysis of a quality improvement program to reduce caesarean sections in Brazilian private hospitals: a case study

“…In 2017, an evaluative research called the “Healthy Birth” study was carried out to assess the degree of implementation and the effects of the PPA in a convenience sample of 12 hospitals, among the 23 private hospitals that participated in the first phase of the project [ 14 ]. Sample calculation used as parameters a 50% prevalence of cesarean section and a power of 80% to detect a 10% reduction in the caesarean rate with a significance level of 5% resulting in a minimum sample of 400 women in each hospital.…”

Cost-Effectiveness Analysis of A Quality Improvement Program to Reduce Cesarean Sections in Brazilian Private Hospitals: A Case Study

“…In 2017, an evaluative research called the "Healthy Birth" study was carried out to assess the degree of implementation and the effects of the PPA in a convenience sample of 12 hospitals, among the 23 private hospitals that participated in the rst phase of the project 14 . Sample calculation used as parameters a 50% prevalence of cesarean section and a power of 80% to detect a 10% reduction in the cesarean rate with a signi cance level of 5% resulting in a minimum sample of 400 women in each hospital.…”