Increasing postpartum IUCD coverage through a QI initiative: a step towards reducing the unmet need of postpartum contraception

BackgroundUnintended pregnancies have a negative impact on the health and economy of a nation, which can be prevented by effective family planning (FP) services. Postpartum intrauterine device (PPIUCD) is a safe and effective FP method which allows women to obtain long-acting contraception before discharge from the point of delivery. We observed poor coverage of deliveries with PPIUCD at our facility. This was the trigger to initiate a quality improvement (QI) initiative to increase the PPIUCD coverage from current rate of 4.5%–10% in 3-month period.MethodA fishbone analysis of the problem was done and the following causes were identified: lack of focused counselling for FP, lack of sensitisation and training of resident doctors and inconsistent supply of intrauterine contraceptive devices (IUCDs). A QI team was constituted with representatives from faculty members, residents, interns, nursing officers and FP counsellors. The point of care quality improvement methodology was used.InterventionsDaily counselling of antenatal women was started by the counsellors and interns in antenatal wards. A WhatsApp group of residents was made initially to sensitise them; and later for parking of problems and trouble shooting. The residents were provided hands-on training at skills lab. Uninterrupted supply of IUCDs was ensured by provision of buffer stock of IUCDs with respective store keepers.ResultThe PPIUCD insertion rates improved from 4.5% to 19.2% at 3 months and have been sustained to a current 30%–35% after 1 ½ years of initiation of the project tiding through the turbulence during the COVID-19 pandemic using QI techniques.ConclusionSensitisation and training of residents as well as creation of awareness among antenatal women through targeted counselling helped improve PPIUCD coverage at the facility. QI initiatives have the potential to facilitate effective implementation of the FP programmes by strategic utilisation of the resources.

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Demography as Diplomacy

Building the Population Bomb ◽

10.1093/oso/9780197558942.003.0006 ◽

2021 ◽

pp. 127-157

Author(s):

Emily Klancher Merchant

Keyword(s):

Developing Countries ◽

Family Planning ◽

Intrauterine Device ◽

Unmet Need ◽

Family Planning Programs ◽

The Social ◽

Philanthropic Organizations ◽

Heads Of State ◽

Development Agendas ◽

And Training

Chapter 5 demonstrates how, in the 1950s and 1960s, U.S.-based philanthropic organizations invested in the growth of demography, the social science of human population dynamics, and used demography to convince heads of state of developing countries to integrate family planning programs into their nation-building and economic development agendas. The Population Council and the Ford Foundation established population research and training centers at major U.S. universities, to which they recruited graduate students from developing countries, with the understanding that they would return home after completing their education to advocate for the establishment of family planning programs. These organizations also funded fertility surveys by American demographers in Africa, Asia, and Latin America that promoted small-family norms and the distribution of new systemic contraceptive technologies, specifically the intrauterine device and birth control pill, and documented the existence of what demographers termed “unmet need” for family planning services.

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Child Care Quality Improvement Project Evaluation: Final Report: Executive Summary

PsycEXTRA Dataset ◽

10.1037/e546902010-001 ◽

2005 ◽

Keyword(s):

Quality Improvement ◽

Child Care ◽

Project Evaluation ◽

Care Quality ◽

Quality Improvement Project ◽

Final Report ◽

Child Care Quality ◽

Executive Summary ◽

Improvement Project

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The use of positive urine dipstick as a screening tool for further testing of suspected urinary tract infection in patients with renal transplant – a care quality improvement study.

10.26226/morressier.58736691d462b80292384205 ◽

2017 ◽

Author(s):

Sidhdharthkumar Shah

Keyword(s):

Urinary Tract Infection ◽

Quality Improvement ◽

Urinary Tract ◽

Renal Transplant ◽

Tract Infection ◽

Screening Tool ◽

Care Quality ◽

Urine Dipstick ◽

Positive Urine

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Patient-Centered, Integrated Health Care Quality Measures Could Improve Health Literacy, Language Access, and Cultural Competence

NAM Perspectives ◽

10.31478/201902a ◽

2019 ◽

Cited By ~ 3

Author(s):

Ignatius Bau ◽

Robert A. Logan ◽

Christopher Dezii ◽

Bernard Rosof ◽

Alicia Fernandez ◽

...

Keyword(s):

Health Care ◽

Quality Improvement ◽

Health Literacy ◽

Cultural Competence ◽

Health Care Quality ◽

Care Quality ◽

National Committee ◽

Patient Centered ◽

Organizational System ◽

Language Access

The authors of this paper recommend the integration of health care quality improvement measures for health literacy, language access, and cultural competence. The paper also notes the importance of patient-centered and equity-based institutional performance assessments or monitoring systems. The authors support the continued use of specific measures such as assessing organizational system responses to health literacy or the actual availability of needed language access services such as qualified interpreters as part of overall efforts to maintain quality and accountability. Moreover, this paper is informed by previous recommendations from a commissioned paper provided by the National Committee for Quality Assurance (NCQA) to the Roundtable on Health Literacy of the National Academies of Sciences, Engineering, and Medicine. In the commissioned paper, NCQA explained that health literacy, language access, and cultural competence measures are siloed and need to generate results that enhance patient care improvements. The authors suggest that the integration of health literacy, language access, and cultural competence measures will provide for institutional assessment across multiple dimensions of patient vulnerabilities. With such integration, health care organizations and providers will be able to cultivate the tools needed to identify opportunities for quality improvement as well as adapt care to meet diverse patients’ complex needs. Similarly, this paper reinforces the importance of providing more “measures that matter” within clinical settings.

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P38 COVID-19 impact on Surgical Training And Recovery Planning (COVID-STAR) Survey

BJS Open ◽

10.1093/bjsopen/zrab032.037 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

◽

Joshua Clements

Keyword(s):

Surgical Training ◽

Negative Impact ◽

Healthcare Delivery ◽

Cross Sectional Study ◽

Surgical Trainee ◽

Surgical Specialty ◽

Cross Sectional ◽

Training Time ◽

Surgical Trainees ◽

And Training

Abstract Background The COVID-19 pandemic has resulted in dynamic changes to healthcare delivery. Surgery as a specialty has been significantly affected and with that the delivery of surgical training. Method This national, collaborative, cross sectional study comprising 13 surgical trainee associations distributed a pan surgical specialty survey on the COVID-19 impact on surgical training over a 4-week period (11th May - 8th June 2020). The survey was voluntary and open to medical students and surgical trainees of all specialties and training grades. All aspects of training were qualitatively assessed. This study was reported according to STROBE guidelines. Results 810 completed responses were analysed. (M401: F 390) with representation from all deaneries and training grades. 41% of respondents (n = 301) were redeployed with 74% (n = 223) redeployed > 4 weeks. Complete loss of training was reported in elective operating (69.5% n = 474), outpatient activity (67.3%, n = 457), Elective endoscopy (69.5% n = 246) with > 50% reduction in training time reported in emergency operating (48%, n = 326) and completion of work-based assessments (WBA) (46%, n = 309). 81% (n = 551) reported course cancellations and departmental and regional teaching programmes were cancelled without rescheduling in 58% and 60% of cases respectively. A perceived lack of Elective operative exposure and completions of WBA’s were the primary reported factor affecting potential training progression. Overall, > 50% of trainees (n = 377) felt they would not meet the competencies required for that training period. Conclusion This study has demonstrated a perceived negative impact on numerous aspects of surgical training affecting all training specialties and grades.

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Evidence-Based Practice Implementation: Case Report of the Evolution of a Quality Improvement Program in a Multicenter Physical Therapy Organization

Physical Therapy ◽

10.2522/ptj.20130541 ◽

2015 ◽

Vol 95 (4) ◽

pp. 588-599 ◽

Cited By ~ 8

Author(s):

Joel M. Stevans ◽

Christopher G. Bise ◽

John C. McGee ◽

Debora L. Miller ◽

Paul Rockar ◽

...

Keyword(s):

Quality Improvement ◽

Case Report ◽

Physical Therapy ◽

Care Quality ◽

Routine Practice ◽

Evidence Based ◽

Implementation Barriers ◽

Improvement Program ◽

Improvement Project ◽

Systems Perspective

Background and Purpose Our nation's suboptimal health care quality and unsustainable costs can be linked to the failure to implement evidence-based interventions. Implementation is the bridge between the decision to adopt a strategy and its sustained use in practice. The purpose of this case report is threefold: (1) to outline the historical implementation of an evidence-based quality improvement project, (2) to describe the program's future direction using a systems perspective to identify implementation barriers, and (3) to provide implications for the profession as it works toward closing the evidence-to-practice gap. Case Description The University of Pittsburgh Medical Center (UPMC) Centers for Rehab Services is a large, multicenter physical therapy organization. In 2005, they implemented a Low Back Initiative utilizing evidence-based protocols to guide clinical decision making. Outcomes The initial implementation strategy used a multifaceted approach. Formative evaluations were used repeatedly to identify barriers to implementation. Barriers may exist outside the organization, they can be created internally, they may result from personnel, or they may be a direct function of the research evidence. Since the program launch, 3 distinct improvement cycles have been utilized to address identified implementation barriers. Discussion Implementation is an iterative process requiring evaluation, measurement, and refinement. During this period, behavior change is actualized as clinicians become increasingly proficient and committed to their use of new evidence. Successfully incorporating evidence into routine practice requires a systems perspective to account for the complexity of the clinical setting. The value the profession provides can be enhanced by improving the implementation of evidence-based strategies. Achieving this outcome will require a concerted effort in all areas of the profession. New skills will be needed by leaders, researchers, managers, and clinicians.

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