scholarly journals Quality of antenatal care services at subcentres: an infrastructure, process and outcome evaluation in a district in Tamil Nadu

2017 ◽  
Vol 4 (11) ◽  
pp. 4071 ◽  
Author(s):  
Sugunadevi G.
Keyword(s):  
Quality Of Care ◽  
Reproductive Health ◽  
Antenatal Care ◽  
Tamil Nadu ◽  
Care Delivery ◽  
Simple Random Sampling ◽  
Outcome Evaluation ◽  
Care Services ◽  
Health Care Delivery Systems

Background: Quality of care is a priority concern all over the world and all the countries are trying to improve the effectiveness and efficiency of their health care delivery systems. Recognizing the potential to improve the reproductive health status in developing countries, quality of care in reproductive health field has been the priority area of research by WHO.Methods: This study assesses the quality of antenatal care services delivered at subcentre level by comparing with the recommended Structural attributes, Process attributes and Initial outcome attributes. By simple random sampling, ten subcentres under three Block Primary Health Centres in Coimbatore district were included in the study.Results: On observing the quality of client-provider interaction, most of the women were treated with dignity (98.5%), but there were deficiencies in examination for pallor (19.2%), pedal edema (18.5%) and pulse (10.6%) which is very critical for good antenatal care. The exit interview revealed that most clients (98.6%) were satisfied with the antenatal care.Conclusions: The findings of this quality assessment study provide information about training needs for improving the quality of service and serves as a baseline data on status before implementing NRHM. 

scholarly journals Current developments in delivering customized care: a scoping review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Etienne Minvielle ◽  
Aude Fourcade ◽  
Thomas Ricketts ◽  
Mathias Waelli
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Health Care Delivery ◽  
Scoping Review ◽  
Care Delivery ◽  
Patient Characteristics ◽  
Delivery Systems ◽  
Segmentation Analysis ◽  
Health Care Delivery Systems

Abstract Background In recent years, there has been a growing interest in health care personalization and customization (i.e. personalized medicine and patient-centered care). While some positive impacts of these approaches have been reported, there has been a dearth of research on how these approaches are implemented and combined for health care delivery systems. The present study undertakes a scoping review of articles on customized care to describe which patient characteristics are used for segmenting care, and to identify the challenges face to implement customized intervention in routine care. Methods Article searches were initially conducted in November 2018, and updated in January 2019 and March 2019, according to Prisma guidelines. Two investigators independently searched MEDLINE, PubMed, PsycINFO, Web of Science, Science Direct and JSTOR, The search was focused on articles that included “care customization”, “personalized service and health care”, individualized care” and “targeting population” in the title or abstract. Inclusion and exclusion criteria were defined. Disagreements on study selection and data extraction were resolved by consensus and discussion between two reviewers. Results We identified 70 articles published between 2008 and 2019. Most of the articles (n = 43) were published from 2016 to 2019. Four categories of patient characteristics used for segmentation analysis emerged: clinical, psychosocial, service and costs. We observed these characteristics often coexisted with the most commonly described combinations, namely clinical, psychosocial and service. A small number of articles (n = 18) reported assessments on quality of care, experiences and costs. Finally, few articles (n = 6) formally defined a conceptual basis related to mass customization, whereas only half of articles used existing theories to guide their analysis or interpretation. Conclusions There is no common theory based strategy for providing customized care. In response, we have highlighted three areas for researchers and managers to advance the customization in health care delivery systems: better define the content of the segmentation analysis and the intervention steps, demonstrate its added value, in particular its economic viability, and align the logics of action that underpin current efforts of customization. These steps would allow them to use customization to reduce costs and improve quality of care.

scholarly journals Nurse Practitioner–Physician Comanagement of Patients in Primary Care

2018 ◽  
Vol 19 (3-4) ◽  
pp. 82-90 ◽  
Author(s):  
Allison A. Norful ◽  
Siqin Ye ◽  
Mieke Van der-Biezen ◽  
Lusine Poghosyan
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
Nurse Practitioner ◽  
Care Delivery ◽  
Qualitative Interviews ◽  
Recommended Care ◽  
Care Services ◽  
Primary Care Services ◽  
Primary Care Delivery

Current demand for primary care services will soon exceed the primary care provider (PCP) workforce capacity. As patient panel sizes increase, it has become difficult for a single PCP to deliver all recommended care. As a result, provider comanagement of the same patient has emerged in practice. Provider comanagement is defined as two or more PCPs sharing care management responsibilities for the same patient. While physician–physician comanagement of patients has been widely investigated, there is little evidence about nurse practitioner (NP)–physician comanagement. Given the large number of NPs that are practicing in primary care, more evidence is warranted about the PCP perspectives of physicians and NPs comanaging patient care. The purpose of this study was to explore NP–physician comanagement in primary care from the perspectives of PCPs. We conducted in-person qualitative interviews of 26 PCPs, including NPs and physicians, that lasted 25 to 45 minutes, were audio recorded, and then professionally transcribed. Transcripts were deidentified and checked for accuracy prior to a deductive and inductive data analysis. Physicians and NPs reported that comanagement increases adherence to recommended care guidelines, improves quality of care, and increases patient access to care. Effective communication, mutual respect and trust, and a shared philosophy of care are essential attributes of NP–physician comanagement. Physicians and NPs are optimistic about comanagement care delivery and find it a promising approach to improve the quality of care and alleviate primary care delivery strain. Efforts to promote effective NP–physician comanagement should be supported in clinical practice.

scholarly journals Healthcare workers’ and pregnant women’s perceptions of digital tools to improve antenatal care

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S van Pelt ◽  
K Massar ◽  
L van der Eem ◽  
M van der Pijl ◽  
L Shields-Zeeman ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Healthcare Workers ◽  
Digital Health ◽  
Quality Of Healthcare ◽  
Care Services ◽  
Rural Tanzania ◽  
Women’S Perceptions

Abstract Background To reduce maternal mortality in rural Tanzania, the need to improve antenatal care remains an urgent priority. Digital health tools are seen as a promising instrument to increase the quality of healthcare in developing countries, but it remains unclear to what extent they are perceived as beneficial during the antenatal care visit. Therefore, the aim of this research was to identify factors that could improve the quality of antenatal care in rural Tanzania, and whether digital health tools would change healthcare workers' and pregnant women's perceptions of quality of care. Methods Semi-structured in-depth interviews were conducted with sixteen healthcare workers and nineteen pregnant women, recruited from various health facilities in Magu District, Tanzania. Results Both healthcare workers and pregnant women possess a positive attitude towards antenatal care and acknowledge its importance. However, they also expressed a need for (structural) improvements in antenatal care services, particularly increased availability of diagnostic tests, and increased performance and motivation of healthcare workers. In addition, healthcare workers indicated a need for more training and better supervision. While both groups expected quality of care to increase should a digital health tool be implemented, they placed more focus on investing in health infrastructure, like the availability of medication and other materials, than investments in digital health. Conclusions Infrastructural improvements, including better communication between healthcare workers and pregnant women, as well as training opportunities and supportive leadership, are necessary before a digital health tool can be expected to increase the quality of antenatal care. Key messages Both healthcare workers and pregnant women acknowledged the need for higher quality antenatal care. Both groups suggested a number of infrastructural improvements, among which the use of a digital health tool.

scholarly journals Implementation of a performance-based financing scheme in Malawi and resulting externalities on the quality of care of non-incentivized services

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stephan Brenner ◽  
Caterina Favaretti ◽  
Julia Lohmann ◽  
Jobiba Chinkhumba ◽  
Adamson S. Muula ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health Services ◽  
Antenatal Care ◽  
Service Provision ◽  
Child Health Services ◽  
Negative Externalities ◽  
Positive Externalities ◽  
Performance Based Financing ◽  
A Performance

Abstract Background Countries in Africa progressively implement performance-based financing schemes to improve the quality of care provided by maternal, newborn and child health services. Beyond its direct effects on service provision, evidence suggests that performance-based financing can also generate positive externalities on service utilization, such as increased use of those services that reached higher quality standards after effective scheme implementation. Little, however, is known about externalities generated within non-incentivized health services, such as positive or negative effects on the quality of services within the continuum of maternal care. Methods We explored whether a performance-based financing scheme in Malawi designed to improve the quality of childbirth service provision resulted positive or negative externalities on the quality of non-targeted antenatal care provision. This non-randomized controlled pre-post-test study followed the phased enrolment of facilities into a performance-based financing scheme across four districts over a two-year period. Effects of the scheme were assessed by various composite scores measuring facilities’ readiness to provide quality antenatal care, as well as the quality of screening, prevention, and education processes offered during observed antenatal care consultations. Results Our study did not identify any statistically significant effects on the quality of ANC provision attributable to the implemented performance-based financing scheme. Our findings therefore suggest not only the absence of positive externalities, but also the absence of any negative externalities generated within antenatal care service provision as a result of the scheme implementation in Malawi. Conclusions Prior research has shown that the Malawian performance-based financing scheme was sufficiently effective to improve the quality of incentivized childbirth service provision. Our findings further indicate that scheme implementation did not affect the quality of non-incentivized but clinically related antenatal care services. While no positive externalities could be identified, we also did not observe any negative externalities attributable to the scheme’s implementation. While performance-based incentives might be successful in improving targeted health care processes, they have limited potential in producing externalities – neither positive nor negative – on the provision quality of related non-incentivized services.

Content of antenatal care and perception about services provided by primary hospitals in Nepal: a convergent mixed methods study

2021 ◽  
Vol 33 (2) ◽  
Author(s):  
Yubraj Acharya ◽  
Nigel James ◽  
Rita Thapa ◽  
Saman Naz ◽  
Rishav Shrestha ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Mixed Methods ◽  
Antenatal Care ◽  
Quality Care ◽  
National Level ◽  
Poor Quality ◽  
Public Hospitals ◽  
World Health ◽  
Outcome Variable

Abstract Background Nepal has made significant strides in maternal and neonatal mortality over the last three decades. However, poor quality of care can threaten the gains, as maternal and newborn services are particularly sensitive to quality of care. Our study aimed to understand current gaps in the process and the outcome dimensions of the quality of antenatal care (ANC), particularly at the sub-national level. We assessed these dimensions of the quality of ANC in 17 primary, public hospitals across Nepal. We also assessed the variation in the ANC process across the patients’ socio-economic gradient. Methods We used a convergent mixed methods approach, whereby we triangulated qualitative and quantitative data. In the quantitative component, we observed interactions between providers (17 hospitals from all 7 provinces) and 198 women seeking ANC and recorded the tasks the providers performed, using the Service Provision Assessments protocol available from the Demographic and Health Survey program. The main outcome variable was the number of tasks performed by the provider during an ANC consultation. The tasks ranged from identifying potential signs of danger to providing counseling. We analyzed the resulting data descriptively and assessed the relationship between the number of tasks performed and users’ characteristics. In the qualitative component, we synthesized users’ and providers’ narratives on perceptions of the overall quality of care obtained through focus group discussions and in-depth interviews. Results Out of the 59 tasks recommended by the World Health Organization, providers performed only 22 tasks (37.3%) on average. The number of tasks performed varied significantly across provinces, with users in province 3 receiving significantly higher quality care than those in other provinces. Educated women were treated better than those with no education. Users and providers agreed that the overall quality of care was inadequate, although providers mentioned that the current quality was the best they could provide given the constraints they faced. Conclusion The quality of ANC in Nepal’s primary hospitals is poor and inequitable across education and geographic gradients. While current efforts, such as the provision of 24/7 birthing centers, can mitigate gaps in service availability, additional equipment, infrastructure and human resources will be needed to improve quality. Providers also need additional training focused on treating patients from different backgrounds equally. Our study also points to the need for additional research, both to document the quality of care more objectively and to establish key determinants of quality to inform policy.

Using Employer Purchasing Power to Improve the Quality of Perinatal Care

PEDIATRICS ◽  
1999 ◽  
Vol 103 (Supplement_E1) ◽  
pp. 248-254 ◽  
Author(s):  
Anne G. Castles ◽  
Arnold Milstein ◽  
Cheryl L. Damberg
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Health Care Services ◽  
Health Care Organizations ◽  
Perinatal Care ◽  
Quality Measurement ◽  
Quality Data ◽  
Purchasing Power ◽  
Care Services

Large employers have become increasingly involved in helping to set the agenda for quality measurement and improvement. Moreover, they are beginning to hold health care organizations accountable for their performance through marketplace incentives, including the public reporting of comparative quality data and the linkage of reimbursement to performance on quality measures. The Pacific Business Group on Health (PBGH) is an employer coalition that has been prominent in establishing models for collaborative quality measurement and improvement in the California marketplace. PBGH's involvement in quality stems from an environment in which purchasers were faced with high health care costs, yet virtually no information with which to assess the value their employees received from that care. Research indicating widespread variation in performance across health care organizations and seemingly limited oversight for quality of care within the industry has further motivated purchasers' efforts to better understand the quality of care being delivered to their em-ployees. Using the purchasing power of employers representing 2.5-million covered lives, PBGH endeavors to encourage the transition of the health care marketplace from one that competes solely on price to one that competes on price and quality. This entails collaborating with the health care industry to develop and publicly report valid performance data for use by both large employers and consumers of health care services. It also includes communicating to the marketplace purchasers' commitment to making purchasing decisions based on quality as well as cost. PBGH efforts to measure, report, and improve quality have been demonstrated by several undertakings in the perinatal care arena, including research to assess cesarean section rates and newborn readmission rates across California hospitals. employer coalition, purchaser, quality measurement, quality improvement, report cards, perinatal quality of care.

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