Criteria for Clinical Audit of the Quality of Hospital-Based Obstetric Care in Developing Countries

By Graham, W.; Wagaarachchi, P. et al. | Bulletin of the World Health Organization, May 2000 | Go to article overview

Criteria for Clinical Audit of the Quality of Hospital-Based Obstetric Care in Developing Countries


Graham, W., Wagaarachchi, P., Penney, G., McCaw-Binns, A., Antwi, K. Yeboah, Hall, M. H., Bulletin of the World Health Organization


Voir page 619 le resume en francais. En la pagina 619 figura un resumen en espanol.

Introduction

Obstetric care of high quality continues to be a key requirement for reducing maternal mortality (1, 2). However, the provision of effective, appropriate, accessible and affordable obstetric care is difficult to define, measure, resource, sustain and evaluate (3-5). Clearly, the urgency of and the means for improving obstetric care vary enormously between the industrialized countries, where less than 1% of maternal deaths occur each year, and the developing countries, where more than 99% occur (Fig. 1) (6). Nevertheless, the notion of best practice is of relevance in both settings. Optimal management of, for example, a case of puerperal sepsis is essentially the same in a major referral hospital in North America as in a district hospital in sub-Saharan Africa. This common ground provides an opportunity for the sharing of approaches, such as that of clinical audit, to improving the quality of obstetric care.

[Figure 1 ILLUSTRATION OMITTED]

Of the three dimensions of health care which may be audited (structure, process and outcome), process, i.e. the delivery of care to patients, is the most relevant to the prevention of maternal death, provided that what is involved is known to improve outcome. Criterion-based clinical audit requires approval by clinicians of a list of concise criteria for care of good quality (7), taking into account the resources available (8). Non-medically qualified audit assistants can then screen the case notes of patients and record whether care has met the agreed criteria. The five classic steps of the audit cycle are shown schematically in Fig. 2. The effectiveness of the cycle can be assessed primarily in terms of change in the proportion of complications where management has met the criteria for good care, although structure, e.g. staffing and facilities, must also be monitored.

[Figure 2 ILLUSTRATION OMITTED]

With regard to the use of criterion-based audit in district hospitals of developing countries, it is not known whether:

-- case selection using international definitions is feasible;

-- realistic criteria for care of good quality can be agreed;

-- documentation is available and adequate to assess whether criteria have been met;

-- feedback and standard setting will be helpful;

-- the quality of care will improve.

The project described here alms to answer these questions by assessing the feasibility and effectiveness of an audit cycle in two district hospitals in Ghana and two in Jamaica, using the before-and-after design intrinsic in audit(9). The care being audited is the assessment and management of life-threatening complications. Primary and tertiary care are also important but are not considered in the study.

The first step, which took six months, was the establishment of best practice. This involved three main activities:

* a systematic review of the literature in order to find evidence of best practice;

* devising workable definitions for complications;

* expert panel meetings to reach agreement on final definitions and criteria.

Methods

In order to carry out a formal literature search, key words were identified and guidelines for the inclusion or exclusion of studies were drawn up (10). Electronic searches were conducted using Medline and the Cochrane Library, and manual searches were performed on standard obstetric texts, relevant WHO publications and unpublished reports from international safe motherhood projects. A provisional list of criteria of best practice was generated from the 136 references that were reviewed. Precedence was given to evidence from randomized controlled trials, and this was followed by evidence from studies with less robust designs. Finally, expert opinion was considered.

The selection of complications was based on their seriousness and whether they could be concisely and unambiguously defined. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

Criteria for Clinical Audit of the Quality of Hospital-Based Obstetric Care in Developing Countries
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.