scholarly journals A practice improvement package at scale to improve management of birth asphyxia in Rwanda: A before-after mixed methods evaluation

2020 ◽  
Author(s):  
Jacqueline Umunyana ◽  
Felix Sayinzoga ◽  
Jim Ricca ◽  
RACHEL FAVERO ◽  
Marcel Manariyo ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Mixed Methods ◽  
Health Outcomes ◽  
Health Workers ◽  
Birth Asphyxia ◽  
Neonatal Outcomes ◽  
Routine Practice ◽  
Educational Method ◽  
Skills Retention ◽  
Clinical Mentorship

Abstract Background: Helping Babies Breathe (HBB) is a competency-based educational method for an evidence-based protocol to manage birth asphyxia in low resource settings. HBB has been shown to improve health worker skills and neonatal outcomes, but studies have documented problems with skills retention and little evidence of effectiveness at large scale in routine practice. This study examined the effect of complementing provider training with clinical mentorship and quality improvement as outlined in the second edition HBB materials. This “system-oriented” approach was implemented in all public health facilities (n=172) in ten districts in Rwanda from 2015 to 2018. Methods: A before-after mixed methods study assessed changes in provider skills and neonatal outcomes related to birth asphyxia. Mentee knowledge and skills were assessed with HBB objective structured clinical exam (OSCE) B pre and post training and during mentorship visits up to one year afterward. The study team extracted health outcome data across the entirety of intervention districts and conducted interviews to gather perspectives of providers and managers on the approach.Results: Nearly forty percent (n= 772) of health workers in maternity units directly received mentorship. Of the mentees who received two or more visits (n=456), sixty percent demonstrated competence (received > 80% score on OSCE B) on the first mentorship visit, and 100% by the sixth. In a subset of 220 health workers followed for an average of five months after demonstrating competence, 98% maintained or improved their score. Three of the tracked neonatal health outcomes improved across the ten districts and the fourth just missed statistical significance: neonatal admissions due to asphyxia (37% reduction); fresh stillbirths (27% reduction); neonatal deaths due to asphyxia (13% reduction); and death within 30 minutes of birth (19% reduction, p=0.06). Health workers expressed satisfaction with the clinical mentorship approach, noting improvements in confidence, patient flow within the maternity, and data use for decision-making. Conclusions: Framing management of birth asphyxia within a larger quality improvement approach appears to contribute to success at scale. Clinical mentorship emerged as a critical element. The specific effect of individual components of the approach on provider skills and health outcomes requires further investigation.

scholarly journals A practice improvement package at scale to improve management of birth asphyxia in Rwanda: A before-after mixed methods evaluation

2019 ◽  
Author(s):  
Jacqueline Umunyana ◽  
Felix Sayinzoga ◽  
Jim Ricca ◽  
Rachel Favero ◽  
Marcel Manariyo ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Mixed Methods ◽  
Health Outcomes ◽  
Health Workers ◽  
Birth Asphyxia ◽  
Neonatal Outcomes ◽  
Routine Practice ◽  
Educational Method ◽  
Skills Retention ◽  
Clinical Mentorship

Abstract Background: Helping Babies Breathe (HBB) is a competency-based educational method for an evidence-based protocol to manage birth asphyxia in low resource settings. HBB has been shown to improve health worker skills and neonatal outcomes, but studies have documented problems with skills retention and little evidence of effectiveness at large scale in routine practice. This study examined the effect of complementing provider training with clinical mentorship and quality improvement as outlined in the second edition HBB materials.This “system-oriented” approach was implemented in all public health facilities (n=172) in ten districts in Rwanda from 2015 to 2018. Methods: A before-after mixed methods study assessed changes in provider skills and neonatal outcomes related to birth asphyxia. Mentee knowledge and skills were assessed with HBB objective structured clinical exam (OSCE) B pre and post training and during mentorship visits up to one year afterward. The study team extracted health outcome data across the entirety of intervention districts and conducted interviews to gather perspectives of providers and managers on the approach. Results: Nearly forty percent (n= 772) of the health workers in maternity units directly received mentorship. Of the mentees who received two or more visits (n=456), sixty percent demonstrated competence (received > 80% score on OSCE B) on the first mentorship visit, and 100% by the sixth. In a subset of 220 health workers followed for an average of five months after demonstrating competence, 98% maintained or improved their score. Three of the tracked neonatal health outcomes improved across the ten districts and the fourth just missed statistical significance: neonatal admissions due to asphyxia (37% reduction); fresh stillbirths (27% reduction); neonatal deaths due to asphyxia (13% reduction); and death within 30 minutes of birth (19% reduction, p=0.06). Health workers expressed satisfaction with the clinical mentorship approach, noting improvements in confidence, patient flow within the maternity, and data use for decision-making. Conclusions: Framing management of birth asphyxia within a larger quality improvement approach appears to contribute to success at scale. Clinical mentorship emerged as a critical element. The specific effect of individual components of the approach on provider skills and health outcomes requires further investigation.

scholarly journals A practice improvement package at scale to improve management of birth asphyxia in Rwanda: A before-after mixed methods evaluation

2020 ◽  
Author(s):  
Jacqueline Umunyana ◽  
Felix Sayinzoga ◽  
Jim Ricca ◽  
RACHEL FAVERO ◽  
Marcel Manariyo ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Mixed Methods ◽  
Health Outcomes ◽  
Health Workers ◽  
Birth Asphyxia ◽  
Neonatal Outcomes ◽  
Routine Practice ◽  
Educational Method ◽  
Skills Retention ◽  
Clinical Mentorship

Abstract Background: Helping Babies Breathe (HBB) is a competency-based educational method for an evidence-based protocol to manage birth asphyxia in low resource settings. HBB has been shown to improve health worker skills and neonatal outcomes, but studies have documented problems with skills retention and little evidence of effectiveness at large scale in routine practice. This study examined the effect of complementing provider training with clinical mentorship and quality improvement as outlined in the second edition HBB materials. This “system-oriented” approach was implemented in all public health facilities (n=172) in ten districts in Rwanda from 2015 to 2018. Methods: A before-after mixed methods study assessed changes in provider skills and neonatal outcomes related to birth asphyxia. Mentee knowledge and skills were assessed with HBB objective structured clinical exam (OSCE) B pre and post training and during mentorship visits up to one year afterward. The study team extracted health outcome data across the entirety of intervention districts and conducted interviews to gather perspectives of providers and managers on the approach. Results: Nearly forty percent (n= 772) of health workers in maternity units directly received mentorship. Of the mentees who received two or more visits (n=456), sixty percent demonstrated competence (received > 80% score on OSCE B) on the first mentorship visit, and 100% by the sixth. In a subset of 220 health workers followed for an average of five months after demonstrating competence, 98% maintained or improved their score. Three of the tracked neonatal health outcomes improved across the ten districts and the fourth just missed statistical significance: neonatal admissions due to asphyxia (37% reduction); fresh stillbirths (27% reduction); neonatal deaths due to asphyxia (13% reduction); and death within 30 minutes of birth (19% reduction, p=0.06). Health workers expressed satisfaction with the clinical mentorship approach, noting improvements in confidence, patient flow within the maternity, and data use for decision-making. Conclusions: Framing management of birth asphyxia within a larger quality improvement approach appears to contribute to success at scale. Clinical mentorship emerged as a critical element. The specific effect of individual components of the approach on provider skills and health outcomes requires further investigation.

scholarly journals A practice improvement package at scale to improve management of birth asphyxia in Rwanda: a before-after mixed methods evaluation

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jacqueline Umunyana ◽  
Felix Sayinzoga ◽  
Jim Ricca ◽  
Rachel Favero ◽  
Marcel Manariyo ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Mixed Methods ◽  
Health Outcomes ◽  
Health Workers ◽  
Birth Asphyxia ◽  
Neonatal Outcomes ◽  
Routine Practice ◽  
Educational Method ◽  
Skills Retention ◽  
Clinical Mentorship

Abstract Background Helping Babies Breathe (HBB) is a competency-based educational method for an evidence-based protocol to manage birth asphyxia in low resource settings. HBB has been shown to improve health worker skills and neonatal outcomes, but studies have documented problems with skills retention and little evidence of effectiveness at large scale in routine practice. This study examined the effect of complementing provider training with clinical mentorship and quality improvement as outlined in the second edition HBB materials. This “system-oriented” approach was implemented in all public health facilities (n = 172) in ten districts in Rwanda from 2015 to 2018. Methods A before-after mixed methods study assessed changes in provider skills and neonatal outcomes related to birth asphyxia. Mentee knowledge and skills were assessed with HBB objective structured clinical exam (OSCE) B pre and post training and during mentorship visits up to 1 year afterward. The study team extracted health outcome data across the entirety of intervention districts and conducted interviews to gather perspectives of providers and managers on the approach. Results Nearly 40 % (n = 772) of health workers in maternity units directly received mentorship. Of the mentees who received two or more visits (n = 456), 60 % demonstrated competence (received > 80% score on OSCE B) on the first mentorship visit, and 100% by the sixth. In a subset of 220 health workers followed for an average of 5 months after demonstrating competence, 98% maintained or improved their score. Three of the tracked neonatal health outcomes improved across the ten districts and the fourth just missed statistical significance: neonatal admissions due to asphyxia (37% reduction); fresh stillbirths (27% reduction); neonatal deaths due to asphyxia (13% reduction); and death within 30 min of birth (19% reduction, p = 0.06). Health workers expressed satisfaction with the clinical mentorship approach, noting improvements in confidence, patient flow within the maternity, and data use for decision-making. Conclusions Framing management of birth asphyxia within a larger quality improvement approach appears to contribute to success at scale. Clinical mentorship emerged as a critical element. The specific effect of individual components of the approach on provider skills and health outcomes requires further investigation.

Mixed methods-onderzoek om beweging en slaap van ouderen in kaart te brengen

KWALON ◽  
2020 ◽  
Vol 25 (3) ◽  
Author(s):  
Julie Vanderlinden ◽  
Sabine Lambers ◽  
Reninka De Koker ◽  
Liza Musch
Keyword(s):  
Mixed Methods ◽  
Health Outcomes ◽  
Elderly People ◽  
Health Workers ◽  
The Elderly ◽  
Healthy Ageing ◽  
Physically Active ◽  
Know How ◽  
Measuring Methods

Mixed methods to measure movement and sleep in the elderly Movement and sleep are both crucial for the elderly in terms of healthy ageing. Staying physically active as people age is positively associated with better sleep and health outcomes. But despite the growing attention to healthy ageing, the elderly don’t always keep up with the applicable guidelines in terms of movement. Furthermore, health workers don’t always know how to measure movement and sleep in elderly in order to advise and help them to better adhere to guidelines. Literature lacks a summary of accessible objective and subjective ways to measure movement and sleep in the elderly. This study combines both objective and subjective measuring methods and elaborates on the practical aspects of their use. This paper highlights the advantages of mixed methods when measuring movement and sleep in elderly people and aims to inform health workers who want to evaluate their patients’ movement and sleep in order to guide them towards a healthier lifestyle.

scholarly journals Monitoring intrapartum fetal heart rates by mothers in labour in two public hospitals: an initiative to improve maternal and neonatal healthcare in Liberia

2020 ◽  
Author(s):  
Korpo Borzie ◽  
Noah Jasper ◽  
David Southall ◽  
Rhona MacDonald ◽  
Adeyemo Abass Kola ◽  
...  
Keyword(s):  
Fetal Heart ◽  
Health Workers ◽  
Birth Asphyxia ◽  
Fetal Monitoring ◽  
Fetal Distress ◽  
Public Hospitals ◽  
Obstetric Complications ◽  
Neonatal Outcomes ◽  
Lateral Tilt ◽  
Cord Prolapse

Abstract Abstract Background: In low-resource settings with few health workers, Fetal Heart Rate (FHR) monitoring in labour can be inconsistent and unreliable. An initiative to improve fetal monitoring was implemented in two public hospitals in rural Liberia; the country with the second lowest number of midwives and nurses in the world (1.007 per 10,000 of the population). The initiative assessed the feasibility of educating women in labour to monitor their own FHR and alert a midwife of changes detected.Methods and Interventions: 474 women admitted in labour without obstetric complications were approached. 461 consented to participate (97%) and 13 declined. Those consenting were trained to monitor their FHR using a sonicaid for approximately one minute immediately following the end of every uterine contraction and to inform a midwife of changes. If changes were confirmed, standard clinical interventions for fetal distress (lateral tilt, intravenous fluids and oxygen) were undertaken and, when appropriate, accelerated delivery by vacuum or Caesarean section. Participants provided views on their experiences; subsequently categorized into themes. Neonatal outcomes regarding survival, need for resuscitation, presence of birth asphyxia, and treatment were recorded.Results: 461 out of 474 women gave consent, of whom 425 (92%) completed the monitoring themselves. 387 of 400 women who gave comments, reported positive and 13 negative experiences. 28 participants reported FHR changes, confirmed in 26 cases with meconium stained liquor in 17. Fetal death was identified on admission during training in one mother. 13 neonates required resuscitation, with 12 admitted to the neonatal unit. One developed temporary seizures suggesting birth asphyxia. All 26 neonates were discharged home apparently well. In 2 mothers, previously unrecognized obstetric complications (cord prolapse and Bandl’s ring with obstructed labour) accompanied FHR changes. Resuscitation was needed in 8 neonates without identified FHR changes including one of birth weight 1.3 Kg who could not be resuscitated. There were no intrapartum stillbirths in participants. Conclusions: Women in labour were able to monitor and detect changes in their FHR. Most found the experience beneficial. The absence of intrapartum stillbirths after admission and the low rate of poor neonatal outcomes are promising and warrant further investigation.

scholarly journals Monitoring intrapartum fetal heart rates by mothers in labour in two public hospitals: an initiative to improve maternal and neonatal healthcare in Liberia

2020 ◽  
Author(s):  
Korpo Borzie ◽  
Noah Jasper ◽  
David Southall ◽  
Rhona MacDonald ◽  
Adeyemo Abass Kola ◽  
...  
Keyword(s):  
Fetal Heart ◽  
Health Workers ◽  
Birth Asphyxia ◽  
Fetal Monitoring ◽  
Fetal Distress ◽  
Public Hospitals ◽  
Obstetric Complications ◽  
Neonatal Outcomes ◽  
Lateral Tilt ◽  
Cord Prolapse

Abstract Background: In low-resource settings with few health workers, Fetal Heart Rate (FHR) monitoring in labour can be inconsistent and unreliable. An initiative to improve fetal monitoring was implemented in two public hospitals in rural Liberia; the country with the second lowest number of midwives and nurses in the world (1.007 per 10,000 of the population). The initiative assessed the feasibility of educating women in labour to monitor their FHR and alert a midwife of changes detected.Methods and Interventions: 474 womenadmitted in labour without obstetric complications were approached. 461 consented to participate (97%) and 13 declined. Those consenting were trained to monitor their FHR using a sonicaid for approximately one minute immediately following the end of every uterine contraction and to inform a midwife of changes. If changes were confirmed, standard clinical interventions for fetal distress (lateral tilt, intravenous fluids and oxygen) were undertaken and, when appropriate, accelerated delivery by vacuum or Caesarean section. Participants provided views on their experiences; subsequently categorized into themes. Neonatal outcomes regarding survival, need for resuscitation, presence of birth asphyxia, and treatment were recorded.Results: 461 out of 474 women gave consent, of whom 425 (92%) completed the monitoring themselves. 387 of 400 women who gave comments, reported positive and 13 negative experiences.28 participants reported FHR changes, confirmed in 26 cases with meconium stained liquor in 17. Fetal death was identified on admission during training in one mother. 13 neonates required resuscitation, with 10 admitted to the neonatal unit. One developed temporary seizures suggesting birth asphyxia. All 26 neonates were discharged home apparently well. In 2 mothers, previously unrecognized obstetric complications (cord prolapse and Bandl’s ring with obstructed labour) accompanied FHR changes. Resuscitation was needed in 8 neonates without identified FHR changes including one of birth weight 1.3 Kg who could not be resuscitated. There were no intrapartum stillbirths in participants. Conclusions: Women in labour were able to monitor and detect changes in their FHR. Most found the experience beneficial. The absence of intrapartum stillbirths after admission and the low rate of poor neonatal outcomes are promising and warrant further investigation.

scholarly journals The Perils of a “My Work Here is Done” Perspective: A Mixed Methods Evaluation of Sustainment of an Intervention to Improve Quality of Transient Ischemic Attack Care

2021 ◽  
Author(s):  
Dawn M Bravata ◽  
Edward J Miech ◽  
Laura J Myers ◽  
Anthony J Perkins ◽  
Ying Zhang ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Of Care ◽  
Mixed Methods ◽  
Transient Ischemic Attack ◽  
Performance Data ◽  
Routine Practice ◽  
Significant Difference ◽  
Ischemic Attack ◽  
Active Implementation

Abstract BACKGROUND Sustaining quality improvement has been recognized as a key implementation challenge. The objectives of this study were to evaluate sustainment during the implementation of a novel quality improvement intervention for Transient Ischemic Attack (TIA) across six geographically diverse medical centers and to identify specific factors contributing to sustainment. METHODS The PREVENT study was a five-year, stepped-wedge implementation trial at six US Department of Veterans Affairs sites; active implementation was initiated in three waves, with two facilities per wave. Six control sites were matched to each of the six PREVENT active implementation sites (total number of control sites was 36). Mixed methods were used to assess change in quality of care from baseline to active implementation to sustainment (measured by the “without-fail rate” and to identify factors which promoted or hindered sustainment. RESULTS The without-fail rate at PREVENT sites improved from 36.7% at baseline to 54.0% during active implementation and settled to 48.3% during sustainment. At control sites, the without-fail rate improved from 38.6% at baseline to 41.8% during active implementation and remained steady at 43.0% during sustainment. Changes in quality of care during sustainment varied across PREVENT sites: the without-fail rate improved at three sites, declined at two sites, and remained unchanged at one site. In adjusted analyses, although the without-fail rate improved at PREVENT sites compared with control sites during active implementation, no statistically significant difference in quality between intervention and control sites was identified during the sustainment phase. Factors that promoted sustainment were integration of key processes of care into routine practice and establishing systems for reflecting and evaluating on performance data to plan quality improvement activities or respond to changes in quality. Challenges during sustainment included competing demands from new facility quality priorities, low patient volume, and potential problems with coding impairing use of performance data. CONCLUSIONS Facilities seeking to sustain evidence-based practices while embodying the Learning Healthcare System’s core values can harness the combined power of staff and data systems by embedding quality improvement processes within routine care and establishing systems for reviewing and reflecting upon performance data.TRIAL REGISTRATION clinicaltrials.gov: NCT02769338

scholarly journals Title: Monitoring intrapartum fetal heart rates by mothers in labour in two public hospitals: an initiative to improve maternal and neonatal healthcare in Liberia

2020 ◽  
Author(s):  
Korpo Borzie ◽  
Noah Jasper ◽  
David Southall ◽  
Rhona MacDonald ◽  
Adeyemo Abass Kola ◽  
...  
Keyword(s):  
Fetal Heart ◽  
Health Workers ◽  
Birth Asphyxia ◽  
Fetal Monitoring ◽  
Fetal Distress ◽  
Public Hospitals ◽  
Obstetric Complications ◽  
Neonatal Outcomes ◽  
Lateral Tilt ◽  
Cord Prolapse

Abstract Background: In low-resource settings with few health workers, Fetal Heart Rate (FHR) monitoring in labour can be inconsistent and unreliable. An initiative to improve fetal monitoring was implemented in two public hospitals in rural Liberia; the country with the second lowest number of midwives and nurses in the world (1.007 per 10,000 of the population). The initiative assessed the feasibility of educating women in labour to monitor their own FHR and alert a midwife of changes detected.Methods: 474 women admitted in labour without obstetric complications were approached. 461 consented to participate (97%) and 13 declined. Those consenting were trained to monitor their FHR using a sonicaid for approximately one minute immediately following the end of every uterine contraction and to inform a midwife of changes. If changes were confirmed, standard clinical interventions for fetal distress (lateral tilt, intravenous fluids and oxygen) were undertaken and, when appropriate, accelerated delivery by vacuum or Caesarean section. Participants provided views on their experiences; subsequently categorized into themes. Neonatal outcomes regarding survival, need for resuscitation, presence of birth asphyxia, and treatment were recorded.Results: 461 out of 474 women gave consent, of whom 425 (92%) completed the monitoring themselves. 387 of 400 women who gave comments, reported positive and 13 negative experiences. 28 participants reported FHR changes, confirmed in 26 cases with meconium stained liquor in 17. Fetal death was identified on admission during training in one mother. 13 neonates required resuscitation, with 12 admitted to the neonatal unit. One developed temporary seizures suggesting birth asphyxia. All 26 neonates were discharged home apparently well. In 2 mothers, previously unrecognized obstetric complications (cord prolapse and Bandl’s ring with obstructed labour) accompanied FHR changes. Resuscitation was needed in 8 neonates without identified FHR changes including one of birth weight 1.3 Kg who could not be resuscitated. There were no intrapartum stillbirths in participants. Conclusions: Women in labour were able to monitor and detect changes in their FHR. Most found the experience beneficial. The absence of intrapartum stillbirths after admission and the low rate of poor neonatal outcomes are promising and warrant further investigation.

scholarly journals Monitoring intrapartum fetal heart rates by mothers in labour in two public hospitals: an initiative to improve maternal and neonatal healthcare in Liberia

2019 ◽  
Author(s):  
Korpo Borzie ◽  
Noah Jasper ◽  
David Southall ◽  
Rhona MacDonald ◽  
Adeyemo Abass Kola ◽  
...  
Keyword(s):  
Fetal Heart ◽  
Health Workers ◽  
Birth Asphyxia ◽  
Fetal Monitoring ◽  
Fetal Distress ◽  
Public Hospitals ◽  
Obstetric Complications ◽  
Neonatal Outcomes ◽  
Lateral Tilt ◽  
Poor Outcomes

Abstract Background: In low-resource settings with few health workers, the Fetal Heart Rate (FHR) in women in labour can be inadequately monitored contributing to poor outcomes. An initiative to improve fetal monitoring was implemented in two public hospitals in rural Liberia with extremely limited health workforces, to assess the feasibility of educating women in labour to monitor their FHR and alert their attending midwife of any changes which might indicate fetal distress. Methods and Interventions: Over 15 months, 474 women admitted in labour without obstetric complications were approached. After informed consent, 461 agreed (97%) and 13 refused. Those consented were trained to monitor the FHR using a sonicaid for approximately one minute immediately after the end of every uterine contraction and inform her midwife of changes. If relevant changes were confirmed, standard clinical interventions for possible fetal distress (lateral tilt and intravenous fluids and glucose) and, when appropriate, accelerated delivery by vacuum or Caesarean section were undertaken. Participants provided views on their monitoring experience; subsequently categorized into themes. Neonatal outcomes regarding survival, need for resuscitation, presence of birth asphyxia, and treatment were recorded. Results: 461 out of 474 women gave consent, of whom 426 (92%) completed the monitoring themselves. 386 (97%) of 400 who gave comments, reported positive experiences and 14 reported only negative experiences. 28 participants identified FHR changes, confirmed in 26 cases. Meconium stained liquor accompanied FHR changes in 18 of these 26 (69%). 13 of these 26 neonates required resuscitation, with 10 admitted to the neonatal unit. One developed temporary seizures suggesting birth asphyxia. All 26 neonates were discharged home apparently well. In 2 mothers, previously unrecognized obstetric complications (cord prolapse and Bandl’s ring with obstructed labour) accompanied FHR changes. Resuscitation was needed in 8 neonates without identified FHR changes. One (birth weight 1.3 Kg) could not be resuscitated. There were no intrapartum stillbirths or maternal deaths in participants. Conclusions: Women in labour were able to monitor and detect changes in their FHR. Most found the experience positive and empowering. The absence of intrapartum stillbirths and low number of poor neonatal outcomes are promising but warrant further research.

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