Evaluation of quality improvement for cesarean sections caesarean section programmes through mixed methods.

Area of Science:

• Obstetrics and Gynecology
• Health Services Research
• Health Economics

Background:

• Avoidable caesarean sections (CS) rates can be reduced by involving healthcare professionals and adhering to clinical practice guidelines (CPGs).
• Quality Improvement for CS (QICS) programs, designed with these principles, have been implemented in Canada and Spain.

Purpose of the Study:

• Identify cost-consequence clusters in Canadian and Spanish QICS programs.
• Determine if demographic, clinical, or contextual factors differentiate these clusters.
• Explore QICS implementation to identify facilitators and challenges in changing practices and reducing obstetric interventions.

Main Methods:

• A mixed-methods approach combining cluster analysis of patient data (105,348 in Quebec, 64,760 in Andalusia) and in-depth interviews with healthcare professionals.
• Quantitative analysis used cluster analysis for CS rates and costs, with t-tests to compare patient and hospital characteristics.
• Qualitative analysis explored implementation factors across political, hospital, and professional levels.

Main Results:

• Cluster analysis identified distinct patterns of CS rates and associated costs in both regions.
• Patient and hospital characteristics were found to differentiate these clusters.
• Interviews revealed key facilitators and challenges in implementing QICS, highlighting the importance of context.

Conclusions:

• The study presents a novel program evaluation approach integrating diverse techniques to account for implementation context.
• Findings offer insights into optimizing QICS programs for effective reduction of caesarean sections.
• Understanding regional specificities is crucial for successful healthcare quality improvement initiatives.