Influence of audit and feedback on use of caesarean section in a geographically-defined population

Kiwanuka, Anthony; Moore, William M.

doi:10.1016/0028-2243(93)90165-9

Cited by 15 publications

(12 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Criterion‐based audit reduced cesarean section rate (three studies with 27,732 participants: OR 0.82, 95% CI 0.73–0.92) (11–13) and improved documentation of cesarean section (one study with 274 participants): type of anesthetic (OR 48.09, 95% CI 16.81–137.62), type of uterine incision (OR 28.86, 95% CI 6.81–122.07), surgical findings (OR 50.32, 95% CI 6.79–372.93), but not the indication for cesarean section (OR 1.39, 95% CI 0.68–2.84) (17). There was significant heterogeneity ( p = 0.04) between studies that assessed the effect of audit on cesarean section rate, presumably due to differences in the type of feedback and recommendations implemented to reduce cesarean section rate.…”

Section: Resultsmentioning

confidence: 99%

Use of criterion‐based clinical audit to improve the quality of obstetric care: A systematic review

Kongnyuy

Uthman

2009

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

Although there is evidence that audit and feedback can improve health outcomes, little is known about the effect of audit on the quality of care from client's perspective. The aim of the current review was to explore the use of criterion-based audit to improve quality of obstetric care from both the midwives/doctors' and women/mothers' perspectives. Electronic searches of Cochrane Library, MEDLINE, and EMBASE were conducted. Randomized controlled trials (RCTs) and before-and-after studies that assessed the effect of criterion-based audit on health outcomes or women/mothers' perception of obstetric care were set as selection criteria. Data were extracted, analyzed using Revman 4.2 software, and results expressed as weighted mean differences for continuous data, and odds ratios for dichotomous data. Nineteen studies (one RCT and 18 before-and-after studies) involving 32,972 participants met our inclusion criteria. None of these studies assessed the effect of audit on quality from the women/mothers' perspective and none of the studies compared the effectiveness of different types of feedback. Ninety-five percentage (18/19) of studies showed significant improvement in at least one standard measured. Criterion-based audit has been used in obstetrics to improve quality from one dimension, namely the midwives/doctors' perspective. Midwives/doctors should consider the use of audit to improve quality of care from the mothers' view. There is need for well-designed RCTs to assess the effectiveness of different types of feedback in criterion-based audit.

show abstract

Section: Resultsmentioning

confidence: 99%

Use of criterion‐based clinical audit to improve the quality of obstetric care: A systematic review

Kongnyuy

Uthman

2009

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

show abstract

“…Two randomised trials comparing audit and feedback to an opinion leader, or no intervention to reduce CS found no difference in rates . On the other hand, several controlled before‐and‐after studies and a metanalysis have suggested that audit and feedback can reduce CS rates . In the metanalysis, which included five studies involving 734 321 women, audit and feedback alone was moderately effective in reducing CS rate and more effective when used in combination with other interventions .…”

Section: Discussionmentioning

confidence: 99%

“…24,25 On the other hand, several controlled before-and-after studies and a metanalysis have suggested that audit and feedback can reduce CS rates. 5,[26][27][28][29] In the metanalysis, which included five studies involving 734 321 women, audit and feedback alone was moderately effective in reducing CS rate and more effective when used in combination with other interventions. 5 Of note, the framework used to perform audit and feedback differed among all the primary studies described.…”

Section: Discussionmentioning

confidence: 99%

Audit and feedback using the Robson classification to reduce caesarean section rates: a systematic review

Boatin

Cullinane

Torloni

et al. 2017

BJOG

View full text Add to dashboard Cite

BackgroundIn most regions worldwide, caesarean section (CS) rates are increasing. In these settings, new strategies are needed to reduce CS rates.ObjectivesTo identify, critically appraise and synthesise studies using the Robson classification as a system to categorise and analyse data in clinical audit cycles to reduce CS rates.Search strategyMedline, Embase, CINAHL and LILACS were searched from 2001 to 2016.Selection criteriaStudies reporting use of the Robson classification to categorise and analyse data in clinical audit cycles to reduce CS rates.Data collectionData on study design, interventions used, CS rates, and perinatal outcomes were extracted.ResultsOf 385 citations, 30 were assessed for full text review and six studies, conducted in Brazil, Chile, Italy and Sweden, were included. All studies measured initial CS rates, provided feedback and monitored performance using the Robson classification. In two studies, the audit cycle consisted exclusively of feedback using the Robson classification; the other four used audit and feedback as part of a multifaceted intervention. Baseline CS rates ranged from 20 to 36.8%; after the intervention, CS rates ranged from 3.1 to 21.2%. No studies were randomised or controlled and all had a high risk of bias.ConclusionWe identified six studies using the Robson classification within clinical audit cycles to reduce CS rates. All six report reductions in CS rates; however, results should be interpreted with caution because of limited methodological quality. Future trials are needed to evaluate the role of the Robson classification within audit cycles aimed at reducing CS rates.Tweetable abstractUse of the Robson classification in clinical audit cycles to reduce caesarean rates.

show abstract

“…This last approach has been shown to be effective in obstetrics 19 when it includes local collaboration with staff and high quality intensive feedback. 25,26 It may be particularly useful for improving practices related to the management of unexpected morbid events. Moreover, local department heads were asked to present and explain the protocol in detail to attending staff, but were not specifically trained to do so.…”

Section: Limited Impact On Management Practicesmentioning

confidence: 99%

Practices for prevention, diagnosis and management of postpartum haemorrhage: impact of a regional multifaceted intervention

Audureau

Deneux‐Tharaux

Lefevre

et al. 2009

BJOG

View full text Add to dashboard Cite

Objective To evaluate the effectiveness of a multifaceted intervention on practices for prevention, diagnosis and management of postpartum haemorrhage (PPH) and on the prevalence of major PPH in a French perinatal network.Design Quasi-experimental before-and-after survey.Setting All maternity units (n = 19) of a French administrative region, operating as a perinatal network.Sample One representative sample of all women delivering in the network, one representative sample of women with PPH deliveries and an exhaustive sample of women with major PPH. Main outcome measures Practices for prevention, diagnosis and management of PPH and prevalence of major PPH.Results After the intervention, the pharmacological prevention of PPH increased from 58.8% to 75.9% of vaginal deliveries (P < 10 )4 ), and the use of blood collecting bags from 3.9% to 76.3% (P < 10 Conclusions The intervention was effective at improving PPHrelated preventive and diagnostic practices in a perinatal network. Improving management practices and reducing the prevalence of major PPH might require a different intervention design.

show abstract

Influence of audit and feedback on use of caesarean section in a geographically-defined population

Cited by 15 publications

References 7 publications

Use of criterion‐based clinical audit to improve the quality of obstetric care: A systematic review

Use of criterion‐based clinical audit to improve the quality of obstetric care: A systematic review

Audit and feedback using the Robson classification to reduce caesarean section rates: a systematic review

Practices for prevention, diagnosis and management of postpartum haemorrhage: impact of a regional multifaceted intervention

Contact Info

Product

Resources

About