The role of digital clinical decision support tool in improving quality of intrapartum and postpartum care: experiences from two states of India

Abstract

Background Computerized clinical decision support (CDSS) –digital information systems designed to improve clinical decision making by providers – is a promising tool for improving quality of care. This study aims to understand the uptake of ASMAN application (defined as completeness of electronic case sheets), the role of CDSS in improving adherence to key clinical practices and delivery outcomes. Methods We have conducted secondary analysis of program data (government data) collected from 81 public facilities across four districts each in two sates of Madhya Pradesh and Rajasthan. The data collected between August –October 2017 (baseline) and the data collected between December 2019 – March 2020 (latest) was analysed. The data sources included: digitized labour room registers, case sheets, referral and discharge summary forms, observation checklist and complication format. Descriptive, univariate and multivariate and interrupted time series regression analyses were conducted. Results The completeness of electronic case sheets was low at postpartum period (40.5%), and in facilities with more than 300 deliveries a month (20.9%). In multivariate logistic regression analysis, the introduction of technology yielded significant improvement in adherence to key clinical practices. We have observed reduction in fresh still births rates and asphyxia, but these results were not statistically significant in interrupted time series analysis. However, our analysis showed that identification of maternal complications has increased over the period of program implementation and at the same time referral outs decreased. Conclusions Our study indicates CDSS has a potential to improve quality of intrapartum care and delivery outcome. Future studies with rigorous study design is required to understand the impact of technology in improving quality of maternity care.

Digital Outcome Optimization: Ensuring a Return Oninvestment of Digital Strategy

“…The benefits of digitalization were found to be specific to the implementation of the technology, were found in every sector, and can be difficult to estimate. Technology can benefit customer satisfaction, competitiveness, productivity, reduce tasks, improve health outcomes, automate information exchanges, and more [38,51,53,56,57]. As examples, this study documented benefits in architecture, engineering, construction, healthcare, manufacturing, and the public sector [36,37,39,44,50,58,59].…”

“…Integrated implementation makes digital gains stable, sustainable, and magnified [47,66,69,72]. Integrated deployment is a real diffusion of innovation that positively impacts outcomes, and every level of the organization [57,60,73]. The evidence clearly supports integrated implementation.…”

“…The potential to support one another, particularly in a new conceptual model of Quality 4.0 has emerged [65,66]. The combination of digitalization and optimization is positively associated [44,57,67,68]. They can be integrated [37,19,52].…”

Use of mHealth tools to register birth outcomes in low-income and middle-income countries: a scoping review

“…Sample sizes also varied between studies: the largest was 46213 and smallest 9 16. Five studies did not document the number of healthcare workers using the technology 12 15 17–19…”

“…21 Analysis of application data showed high rates of data collection for delivery in the app, at 93.7%. 18 Digital collection for specific birth outcomes Three technologies were designed to report a specific outcome, and recorded delivery details as part of the workflow. A system for community midwives to report postpartum haemorrhage (PPH) was designed in Rwanda, using mobile phone handsets and SMS protocols.…”