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Impact Evaluation of PRONTO Mexico: A Simulation-Based Program in Obstetric and Neonatal Emergencies and Team
Dilys M Walker1, Susanna R Cohen, Jimena Fritz
1From the Department of Obstetrics and Gynecology and Global Health (D.M.W.), University of Washington, Seattle, WA; College of Nursing (S.R.C.), University of Utah, Salt Lake City, UT; Division of Reproductive Health (J.F., M.O., A.M., H.L.-F.), Research Center for Population Health, National Institute of Public Health, Cuernavaca, Mexico; Department of Global Health (S.T.Z.), University of Washington, Seattle, WA; Department of Obstetrics and Gynecology (J.O.F.), University of Maryland School of Medicine, Baltimore, MD; and Center for Evaluation Research and Surveys (M.R.-M.), National Institute of Public Health, Cuernavaca, Mexico.
The PRONTO training program significantly reduced cesarean deliveries in Mexican hospitals. While it showed a promising initial decrease in neonatal mortality, the long-term sustainability requires further investigation.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Care
- Medical Education
Background:
- Maternal deaths in Mexico are often linked to suboptimal care within health facilities.
- Improving emergency obstetric and neonatal care is crucial for better health outcomes.
- The PRONTO program offers simulation-based, low-cost emergency training for obstetric and neonatal care teams.
Purpose of the Study:
- To evaluate the impact of the PRONTO training program on patient outcomes in Mexican public hospitals.
- To assess the effect of simulation-based team training on maternal and neonatal mortality and cesarean delivery rates.
Main Methods:
- A pair-matched hospital-based trial involving 24 public hospitals in Mexico (2010-2013).
- Intervention hospitals received PRONTO training; control hospitals did not.
- Mixed-effects negative binomial regression models were used to analyze neonatal mortality, maternal complications, and cesarean delivery rates at 4, 8, and 12 months post-intervention.
Main Results:
- PRONTO training led to a significant cumulative decrease in cesarean sections (21%) over 12 months.
- A significant reduction in neonatal mortality (40%) was observed at 8 months post-intervention, but not at 4 or 12 months.
- No statistically significant impact was found on the incidence of maternal complications.
Conclusions:
- The PRONTO program effectively reduced cesarean delivery rates.
- The training may improve neonatal mortality, but its sustainability requires further research.
- Further studies are needed to confirm the lasting impact of obstetric and neonatal emergency simulation and team training on patient outcomes.
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