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Multifaceted intervention to improve obstetric practices: The OPERA cluster-randomized controlled trial.

Corinne Dupont1, Norbert Winer2, Muriel Rabilloud3

  • 1Hôpital de la Croix-Rousse, Hospices Civils de Lyon, F-69004, Lyon, France; Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France.

European Journal of Obstetrics, Gynecology, and Reproductive Biology
|June 27, 2017
PubMed
Summary

A multifaceted program improved obstetric care by reducing suboptimal care in maternal morbidity cases and lowering perinatal morbidity incidence. However, it did not significantly decrease combined morbidity and mortality rates.

Keywords:
Cluster-randomized trialMorbidity and mortality conferencesPerinatal morbidity and mortalityProfessional practicesProgram evaluationPsychologists

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Area of Science:

  • Obstetrics and Gynecology
  • Public Health
  • Healthcare Quality Improvement

Background:

  • Suboptimal obstetric care is a significant contributor to perinatal morbidity and mortality.
  • Improving obstetric practices is crucial for enhancing maternal and infant outcomes.

Purpose of the Study:

  • To evaluate the effectiveness of a multifaceted program aimed at improving obstetric practices and outcomes.
  • To assess the impact of an intervention combining guideline dissemination with morbidity/mortality conferences on suboptimal care rates.

Main Methods:

  • A cluster-randomized trial involving 95 French maternity units from October 2008 to November 2010.
  • Intervention group received an outreach visit and morbidity/mortality conferences; control group applied guidelines freely.
  • Primary outcome: rate of suboptimal care in perinatal morbidity/mortality cases. Secondary outcomes included avoidable cases and incidence of morbidity/mortality.

Main Results:

  • The intervention significantly reduced suboptimal care in morbidity cases (7.6% vs. 11.5%, p=0.02) and the incidence of perinatal morbidity (7.0‰ vs. 8.1‰, p=0.01).
  • No significant difference was observed in the combined rate of suboptimal care for morbidity plus mortality cases (8.1% vs. 10.6%, p=0.15).
  • Inclusion of clinical psychologists in morbidity/mortality conferences did not yield additional benefits.

Conclusions:

  • The multifaceted program effectively reduced suboptimal care in maternal morbidity and decreased the incidence of perinatal morbidity.
  • The intervention did not significantly improve combined morbidity and mortality outcomes.
  • Further research with longer study periods and broader intervention scopes is needed to impact mortality rates.