Abstract:
BACKGROUND:The rate of avoidable caesarean sections (CS) could be reduced through multifaceted strategies focusing on the involvement of health professionals and compliance with clinical practice guidelines (CPGs). Quality improvements for CS (QICS) programmes (QICS) based on this approach, have been implemented in Canada and Spain. OBJECTIVES:Their objectives are as follows: 1) Toto identify clusters in each setting with similar results in terms of cost-consequences, 2) Toto investigate whether demographic, clinical or context characteristics can distinguish these clusters, and 3) Toto explore the implementation of QICS in the 2 regions, in order to identify factors that have been facilitators in changing practices and reducing the use of obstetric intervention, as well as the challenges faced by hospitals in implementing the recommendations. METHODS:Descriptive study with a quantitative and qualitative approach. 1) Cluster analysis at patient level with data from 16 hospitals in Quebec (Canada) (n = 105,348) and 15 hospitals in Andalusia (Spain) (n = 64,760). The outcome measures are CS and costs. For the cost, we will consider the intervention, delivery and complications in mother and baby, from the hospital perspective. Cluster analysis will be used to identify participants with similar patterns of CS and costs based, and t tests will be used to evaluate if the clusters differed in terms of characteristics: Hospital level (academic status of hospital, level of care, supply and demand factors), patient level (mother age, parity, gestational age, previous CS, previous pathology, presentation of the baby, baby birth weight). 2) Analysis of in-depth interviews with obstetricians and midwives in hospitals where the QICS were implemented, to explore the differences in delivery-related practices, and the importance of the different constructs for positive or negative adherence to CPGs. Dimensions: political/management level, hospital level, health professionals, mothers and their birth partner. DISCUSSION:This work sets out a new approach for programme evaluation, using different techniques to make it possible to take into account the specific context where the programmes were implemented.
journal_name
Implement Scijournal_title
Implementation science : ISauthors
Bermúdez-Tamayo C,Johri M,Perez-Ramos FJ,Maroto-Navarro G,Caño-Aguilar A,Garcia-Mochon L,Aceituno L,Audibert F,Chaillet Ndoi
10.1186/s13012-014-0182-0subject
Has Abstractpub_date
2014-12-11 00:00:00pages
182issn
1748-5908pii
s13012-014-0182-0journal_volume
9pub_type
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journal_title:Implementation science : IS
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journal_title:Implementation science : IS
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journal_title:Implementation science : IS
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journal_title:Implementation science : IS
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journal_title:Implementation science : IS
pub_type: 杂志文章
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journal_title:Implementation science : IS
pub_type: 杂志文章,已发布勘误
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更新日期:2019-02-08 00:00:00
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journal_title:Implementation science : IS
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journal_title:Implementation science : IS
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