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Results of a person-centered maternal health quality improvement intervention in Uttar Pradesh, India

Author

Listed:
  • Dominic Montagu
  • Katie Giessler
  • Michelle Kao Nakphong
  • Kali Prasad Roy
  • Ananta Basudev Sahu
  • Kovid Sharma
  • Cathy Green
  • May Sudhinaraset

Abstract

Background: Poor patient experiences during delivery in Uttar Pradesh, India is a common problem. It delays presentation at facilities after the onset of labor and contributes to poor maternal health outcomes. Patient-centered maternity care (PCMC) is recognized by the World Health Organization as critical to overall quality. Changing PCMC requires changing the process of care, and is therefore especially challenging. Methods: We used a matched case-control design to evaluate a quality improvement process directed at PCMC and based on widely established team-based methods used in many OECD countries. The intervention was introduced into three government facilities and teams supported to brainstorm and test improvements over 12 months. Progress was measured through pre-post interviews with new mothers, scored using a validated PCMC scale. Analysis included chi-squared and difference-in-difference tests. Findings: On a scale to 100, the PCMC score of the intervention group increased 22.9 points compared to controls. Deliveries attended by midwives, dais, ASHAs or non-skilled providers resulted in significantly higher PCMC scores than those attended to by nurses or doctors. The intervention was associated with one additional visit from a doctor and over two additional visits from nurses per day, compared to the control group. Interpretation: This study has demonstrated the effectiveness of a team-based quality improvement intervention to ameliorate women’s childbirth experiences. These improvements were locally designed and led, and offer a model for potential replication.

Suggested Citation

  • Dominic Montagu & Katie Giessler & Michelle Kao Nakphong & Kali Prasad Roy & Ananta Basudev Sahu & Kovid Sharma & Cathy Green & May Sudhinaraset, 2020. "Results of a person-centered maternal health quality improvement intervention in Uttar Pradesh, India," PLOS ONE, Public Library of Science, vol. 15(12), pages 1-14, December.
    • Handle: RePEc:plo:pone00:0242909
    DOI: 10.1371/journal.pone.0242909
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    References listed on IDEAS

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    1. Gaurav Sharma & Timothy Powell-Jackson & Kaveri Haldar & John Bradley & Véronique Filippi, 2017. "Quality of routine essential care during childbirth: Clinical observations of uncomplicated births in Uttar Pradesh, India," WIDER Working Paper Series wp-2017-143, World Institute for Development Economic Research (UNU-WIDER).
    2. Graeme D. Ruxton & Guy Beauchamp, 2008. "Time for some a priori thinking about post hoc testing," Behavioral Ecology, International Society for Behavioral Ecology, vol. 19(3), pages 690-693.
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