The role of digital clinical decision support tool in improving quality of intrapartum and postpartum care: experiences from two states of India

Gulnoza Usmanova,Anand Kumar Bairagi,Tarun Chaudhary,Chandra Shekhar Joshi,Rashmi Dhoundiyal,Pompy Sridhar,Mohammed Afzal,Nupur Bahl,Kamlesh Lalchandani,Bulbul Sood,Yashpal Jain,Archana Mishra,Deepak Chandra Bhatt,Ashish Srivastava,Rajni Wadhwa,Jyoti Benawri,Pratibha Gaikwad

doi:10.1186/s12884-021-03710-y

Abstract

BackgroundComputerized clinical decision support (CDSS) –digital information systems designed to improve clinical decision making by providers – is a promising tool for improving quality of care. This study aims to understand the uptake of ASMAN application (defined as completeness of electronic case sheets), the role of CDSS in improving adherence to key clinical practices and delivery outcomes.MethodsWe have conducted secondary analysis of program data (government data) collected from 81 public facilities across four districts each in two sates of Madhya Pradesh and Rajasthan. The data collected between August –October 2017 (baseline) and the data collected between December 2019 – March 2020 (latest) was analysed. The data sources included: digitized labour room registers, case sheets, referral and discharge summary forms, observation checklist and complication format. Descriptive, univariate and multivariate and interrupted time series regression analyses were conducted.ResultsThe completeness of electronic case sheets was low at postpartum period (40.5%), and in facilities with more than 300 deliveries a month (20.9%). In multivariate logistic regression analysis, the introduction of technology yielded significant improvement in adherence to key clinical practices. We have observed reduction in fresh still births rates and asphyxia, but these results were not statistically significant in interrupted time series analysis. However, our analysis showed that identification of maternal complications has increased over the period of program implementation and at the same time referral outs decreased.ConclusionsOur study indicates CDSS has a potential to improve quality of intrapartum care and delivery outcome. Future studies with rigorous study design is required to understand the impact of technology in improving quality of maternity care.

Highlights

It has been proven that effective and quality of care at the facility level, around childbirth and immediately after the birth, can significantly contribute to the reduction of maternal deaths, stillbirths and neonatal deaths [1, 2]
It is imperative to identify and test innovative solutions for improving quality of care in order to accelerate reduction in maternal and neonatal death in India. One such solution is computerized clinical decision support (CDSS) –digital information systems designed to improve clinical decision making by providers – a promising tool for improving quality of care by improving adherence to clinical guidelines [12, 13], practitioner’s performance [12, 14], patient outcomes [15,16,17], and quality of clinical documentation [18], contributing to quality improvement and overall efficiency of health care delivery
ASMAN intervention In this paper we describe the findings from implementation of “ASMAN” (The Alliance for Saving Mothers and Newborns) a provider-focused package of interventions that leverages technology to reduce maternal and early neonatal mortality through the adoption of key technologies that improve capacity-building and service delivery efforts focused on the provision of quality care during childbirth and the first 48–60 h after delivery

Summary

Introduction

It has been proven that effective and quality of care at the facility level, around childbirth and immediately after the birth, can significantly contribute to the reduction of maternal deaths, stillbirths and neonatal deaths [1, 2]. One such solution is computerized clinical decision support (CDSS) –digital information systems designed to improve clinical decision making by providers – a promising tool for improving quality of care by improving adherence to clinical guidelines [12, 13], practitioner’s performance [12, 14], patient outcomes [15,16,17], and quality of clinical documentation [18], contributing to quality improvement and overall efficiency of health care delivery. This study aims to understand the uptake of ASMAN application (defined as completeness of electronic case sheets), the role of CDSS in improving adherence to key clinical practices and delivery outcomes

Objectives

Methods

Results

Conclusion