Indicators for monitoring maternal and neonatal quality care: a systematic review

Abstract

BackgroundResearch and different organizations have proposed indicators to monitor the quality of maternal and child healthcare, such indicators are used for different purposes.ObjectiveTo perform a systematic review of indicators for the central phases of the maternal and child healthcare continuum of care (pregnancy, childbirth, newborn care and postpartum).MethodA search conducted using international repositories, national and international indicator sets, scientific articles published between 2012 and 2016, and grey literature. The eligibility criteria was documents in Spanish or English with indicators to monitor aspects of the continuum of care phases of interest.The identified indicators were characterized as follows: formula, justification, evidence level, pilot study, indicator type, phase of the continuum, intended organizational level of application, level of care, and income level of the countries. Selection was based on the characteristics associated with scientific soundness (formula, evidence level, and reliability).ResultsWe identified 1791 indicators. Three hundred forty-six were duplicated, which resulted in 1445 indicators for analysis. Only 6.7% indicators exhibited all requirements for scientific soundness. The distribution by the classifying variables is clearly uneven, with a predominance of indicators for childbirth, hospital care and facility level.ConclusionsThere is a broad choice of indicators for maternal and child healthcare. However, most indicators lack demonstrated scientific soundness and refer to particular continuum phases and levels within the healthcare system. Additional efforts are needed to identify good indicators for a comprehensive maternal and child healthcare monitoring system.Electronic supplementary materialThe online version of this article (10.1186/s12884-019-2173-2) contains supplementary material, which is available to authorized users.

Translating international guidelines for use in routine maternal and neonatal healthcare quality measurement

“…They concluded that the volume of existing indicators overwhelms national and local leaders interested in establishing monitoring systems and that more effort is required to better harmonize indicators across the numerous global monitoring initiatives [ 10 , 35 ]. A recent systematic review of indicators related to maternal and child healthcare reported that of the 1791 indicators identified, only 6.7% were evidence-based, reliable, and demonstrated to be feasible [ 36 ]. Despite this high volume of existing indicators, authors cited gaps in the continuum of care, including those covering the postpartum period, especially for the mother, those focused at the primary care level, and those with specific considerations for LMIC settings [ 36 ].…”

“…A recent systematic review of indicators related to maternal and child healthcare reported that of the 1791 indicators identified, only 6.7% were evidence-based, reliable, and demonstrated to be feasible [ 36 ]. Despite this high volume of existing indicators, authors cited gaps in the continuum of care, including those covering the postpartum period, especially for the mother, those focused at the primary care level, and those with specific considerations for LMIC settings [ 36 ]. Work to understand the validity of MNH indicators demonstrated that indicators that are meaningful to users, and reflect the reality of service provision, will lead to quality of care improvements, as well as improvements in MNH health outcomes [ 23 ].…”

“…Indicators for all aspects of maternal and newborn healthcare should be evidence-based, associated with important maternal and newborn health outcomes that can be influenced by provider actions, easy to measure reliably and across various settings, effective at differentiating between good and poor care, acceptable to healthcare providers, and affordable to implement [21]. Yet large lists of maternal and neonatal (MNH) related indicators exist, and recent research has shown that defining a feasible set of evidence-based indicators continues to be a challenge [23,24].…”

Obstetrical safety indicators for preventing hospital harms in low risk births: a scoping review protocol

“…27 A systematic review by Saturno-Hernández et al found that despite the existence of a large number of indicators for monitoring obstetric care, they were lacking in scientific rigour and many are not suitable for implementation. 28 They used the following desirable criteria for indicators: presenting a full description, clearly based on explicit evidence, reliable and feasible (confirmed by pilot testing).…”

“What gets measured better gets done better”: The landscape of validation of global maternal and newborn health indicators through key informant interviews

“…There has been a rapid expansion in the number and range of indicators used by global initiatives to track maternal and newborn programmes. [8, 9] The measurement of maternal and newborn health has a long history of assessing the performance of indicators in capturing their intended meaning, and more broadly, their usefulness in tracking changes that lead to improved maternal and newborn survival. Validity is one consideration in assessing indicator performance and suitability.…”