Catalytic Support for Improving Clinical Care in Special Newborn Care Units (SNCU) Through Composite SNCU Quality of Care Index (SQCI)

Abstract

To develop a composite index that serves as a proxy marker of quality of clinical service and pilot test its use in 11 special neonatal care units (SNCUs) across two states in India. Secondary data from SNCU webportal. Special new-born care units in Rajasthan and Orissa. We developed a composite SNCU Quality of care Index (SQCI) based on seven indices from SNCU online database. These included rational admission index, index for rational use of antibiotics, inborn birth asphyxia index, index for mortality in normal weight babies, low birth weight admission index, low birth weight survival index, and optimal bed utilization index. Based on the SQCI score, the performance of SNCUs was labelled as good (SQCI 0.71- 1.0), satisfactory (SQCI 0.4- 0.7) or unsatisfactory (SQCI <0.4). The mean difference in SQCI between Jan-Mar 2016 and 2017 was 0.20 (95% CI 0.13- 0.28; P<0.001). Similar results were obtained for rational admission index, rational use of antibiotics, mortality in normal weight babies, low birth weight survival and optimal bed utilization. A significant improvement in the overall composite score was noted in Odisha (Mean difference 0.22, 95% CI 0.11-0.33, P=0.003) and Rajasthan (Mean difference 0.17, 95% CI 0.05- 0.3, P=0.002). QI approach using SQCI tool is a useful and replicable intervention. Preliminary results show that it does lead to strengthening of implementation of the programs at SNCUs based on the comprehensive scores generated as part of routine system.