How accurate are medical record data in Afghanistan's maternal health facilities? An observational validity study

Abstract

ObjectivesImprovement activities, surveillance and research in maternal and neonatal health in Afghanistan rely heavily on medical record data. This study investigates accuracy in delivery care records from three hospitals across workshifts.DesignObservational cross-sectional study.SettingThe study was conducted in one maternity hospital, one general hospital maternity department and one provincial hospital maternity department. Researchers observed vaginal deliveries and recorded observations to later check against data recorded in patient medical records and facility registers.Outcome measuresWe determined the sensitivity, specificity, area under the receiver operator characteristics curves (AUROCs), proportions correctly classified and the tendency to make performance seem better than it actually was.Results600 observations across the three shifts and three hospitals showed high compliance with active management of the third stage of labour, measuring blood loss and uterine contraction at 30 min, cord care, drying and wrapping newborns and Apgar scores and low compliance with monitoring vital signs. Compliance with quality indicators was high and specificity was lower than sensitivity. For adverse outcomes in birth registries, specificity was higher than sensitivity. Overall AUROCs were between 0.5 and 0.6. Of 17 variables that showed biased errors, 12 made performance or outcomes seem better than they were, and five made them look worse (71% vs 29%, p=0.143). Compliance, sensitivity and specificity varied less among the three shifts than among hospitals.ConclusionsMedical record accuracy was generally poor. Errors by clinicians did not appear to follow a pattern of self-enhancement of performance. Because successful improvement activities, surveillance and research in these settings are heavily reliant on collecting accurate data on processes and outcomes of care, substantial improvement is needed in medical record accuracy.

Development and Validation of an Index to Measure the Quality of Facility-Based Labor and Delivery Care Processes in Sub-Saharan Africa

“…This study is one of the few in developing countries with data on actual observations of labor and delivery. Observations may provide improvements in accuracy and specificity that counter disadvantages in terms of a Hawthorne effect [ 45 , 47 – 48 , 73 ]. Many recent studies identifying important indicators of QoC during the L&D period have been limited to expert surveys and literature reviews [ 74 – 75 ].…”

“…maternity registers). Numerous studies have documented poor quality and limited sensitivity of obstetric facility records and databases for assessing the performance of care processes in both low- and high-resource settings [ 45 – 51 ].…”

“Every Newborn-BIRTH” protocol: observational study validating indicators for coverage and quality of maternal and newborn health care in Bangladesh, Nepal and Tanzania

“…Validation of facility registers have focussed on outcome measures [29]. The EN-BIRTH study seeks to validate both routine registers and maternal recall at discharge for coverage indicators of high impact interventions.…”

“…Globally more than 75% of babies are now born in facilities, and local count data from routine registers is increasingly available [27]. Whilst health-facility data can be used to track coverage more frequently than surveys, previous studies have demonstrated mixed data quality [28][29][30]. Health workers recording the care they deliver face many barriers in documentation [31,32].…”

“…Previous validation studies have mainly focused on population-based intervention coverage indicators for use in household surveys [25,[46][47][48]. Observational studies to determine accuracy of facility registers in high burden settings have typically focused on outcome indicators [29]. The EN-BIRTH study seeks to address current evidence gaps by testing validity of priority coverage indicators for newborn and maternal health, in facilities in three high burden country settings.…”