A comparison of intensive vs. light-touch quality improvement interventions for maternal health in Uttar Pradesh, India

Dominic Montagu,Ananta Basudev Sahu,Cathy Green,May Sudhinarset,Katie Giessler,Kovid Sharma,Kali Prosad Roy,Michelle Kao Nakphong

doi:10.1186/s12913-020-05960-6

Abstract

BackgroundPoor patient experiences during delivery leads to delayed presentation at facilities and contributes to poor maternal health outcomes. Person-centered maternity care (PCMC) is a key component of quality. Improving PCMC requires changing the process of care which can be complex and necessitate significant external input, making replication and scale difficult. This study compares the effectiveness two Quality Improvement (QI) intervention phases, one Intensive, one Light-Touch.MethodsWe use a matched case-control design to compare two phases of a QI Intervention targeting PCMC, with three facilities in each. The Intensive phase was introduced into three government facilities where teams were supported to identify, design, and test potential improvements over 12 months. The Light-Touch phase was subsequently introduced in three other government facilities and changes were tracked over six months. We compared the two groups using multivariate linear regression and difference-in-difference models to assess changes in PCMC outcomeResultsBoth Intensive and Light-Touch arms demonstrated large improvements in PCMC. On a scale from 0 to 100, Intensive facilities increased in PCMC scores from 85.02 to 97.13, while Light-Touch facilities increased from 63.42 to 87.47. For both there was a ‘halo’ effect, with a similar improvement recorded for the specific improvement activities focused on, as w ell as aspects of PCMC not directly addressed.ConclusionsThis study demonstrates that a short, inexpensive, light-touch and directive intervention can change staff practices and significantly improve the experiences of women during childbirth. It also shows that improvements in a few areas of provider-patient interaction have a ‘halo’ effect, changing many other aspects of patient-provider interaction at the same time.Trial registrationQI Phase 1 - NCT04208867. Retrospectively registered. December 19th, 2019.QI Phase 2 –NCT04208841. Retrospectively registered. December 23, 2019.

Highlights

PrivacyPosition of choice Clean bathroomExplain test and medicine purposePain medicines given when neededHelped to the toiletClean post-natal care ward aTotal, change package, non-change package and subdomain scores were scaled to a 100-point scale bDenotes Non-change package indicator (0.33)of facilities that don’t have this prior experience
Change package indicators We investigated eight targeted Person-centered maternity care (PCMC) indicators that were the focus of the Change Package, hereby referred to as “Change Package PCMC score”
More participants at Intensive facilities had pregnancy complications than those at Light Touch facilities at baseline, but no significant difference was observed at endline

Summary

Introduction

PrivacyPosition of choice Clean bathroomExplain test and medicine purposePain medicines given when neededHelped to the toiletClean post-natal care ward aTotal, change package, non-change package and subdomain scores were scaled to a 100-point scale bDenotes Non-change package indicator (0.33)of facilities that don’t have this prior experience. Towards the end of the Intensive phase, the project’s facilities received attention to a phased expansion of the Government of India’s national initiative to improve the clinical and experiential quality of care in labor rooms and maternity hospitals [15]. This may have influenced the receptiveness of facility leadership to the improvement Interventions in this study, in the lighttouch phase. The importance of person-centered maternity care (PCMC) and client experience is a central component of quality in need of improvement [7]

Methods

Results

Conclusion