Academic Journal
An implementation analysis of a quality improvement project to reduce cesarean section in Brazilian private hospitals
| العنوان: | An implementation analysis of a quality improvement project to reduce cesarean section in Brazilian private hospitals |
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| المؤلفون: | Torres, Jacqueline Alves, Leite, Tatiana Henriques, Fonseca, Thaís Cristina Oliveira, Domingues, Rosa Maria Soares Madeira, Figueiró, Ana Claudia, Pereira, Ana Paula Esteves, Theme-Filha, Mariza Miranda, da Silva Ayres, Bárbara Vasques, Scott, Oliver, de Cássia Sanchez, Rita, Borem, Paulo, de Maio Osti, Maria Carolina, Rosa, Marcos Wengrover, Andrade, Amanda S., Filho, Fernando Maia Peixoto, Nakamura-Pereira, Marcos, do Carmo Leal, Maria |
| المساهمون: | Conselho Nacional de Desenvolvimento Científico e Tecnológico, Bill and Melinda Gates Foundation |
| المصدر: | Reproductive Health ; volume 20, issue S2 ; ISSN 1742-4755 |
| بيانات النشر: | Springer Science and Business Media LLC |
| سنة النشر: | 2024 |
| الوصف: | Background Brazil has one of the highest prevalence of cesarean sections in the world. The private health system is responsible for carrying out most of these surgical procedures. A quality improvement project called Adequate Childbirth Project (“Projeto Parto Adequado”- PPA) was developed to identify models of care for labor and childbirth, which place value on vaginal birth and reduce the frequency of cesarean sections without a clinical indication. This research aims to evaluate the implementation of PPA in private hospitals in Brazil. Method Evaluative hospital-based survey, carried out in 2017, in 12 private hospitals, including 4,322 women. We used a Bayesian network strategy to develop a theoretical model for implementation analysis. We estimated and compared the degree of implementation of two major driving components of PPA—“Participation of women” and “Reorganization of care” – among the 12 hospitals and according to type of hospital (belonging to a health insurance company or not). To assess whether the degree of implementation was correlated with the rate of vaginal birth data we used the Bayesian Network and compared the difference between the group “Exposed to the PPA model of care” and the group “Standard of care model”. Results PPA had a low degree of implementation in both components “Reorganization of Care” (0.17 – 0.32) and “Participation of Women” (0.21 – 0.34). The combined implementation score was 0.39–0.64 and was higher in hospitals that belonged to a health insurance company. The vaginal birth rate was higher in hospitals with a higher degree of implementation of PPA. Conclusion The degree of implementation of PPA was low, which reflects the difficulties in changing childbirth care practices. Nevertheless, PPA increased vaginal birth rates in private hospitals with higher implementation scores. PPA is an ongoing quality improvement project and these results demonstrate the need for changes in the involvement of women and the care offered by the provider. |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| DOI: | 10.1186/s12978-024-01773-6 |
| DOI: | 10.1186/s12978-024-01773-6.pdf |
| DOI: | 10.1186/s12978-024-01773-6/fulltext.html |
| الاتاحة: | http://dx.doi.org/10.1186/s12978-024-01773-6 https://link.springer.com/content/pdf/10.1186/s12978-024-01773-6.pdf https://link.springer.com/article/10.1186/s12978-024-01773-6/fulltext.html |
| Rights: | https://creativecommons.org/licenses/by/4.0 ; https://creativecommons.org/licenses/by/4.0 |
| رقم الانضمام: | edsbas.2E48997B |
| قاعدة البيانات: | BASE |
| DOI: | 10.1186/s12978-024-01773-6 |
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