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Published on: February 19, 2021
Effect of a perinatal care quality improvement package on patient satisfaction: a secondary outcome analysis of a
Olivia Brunell1, Dipak Chaulagain2, Ashish Kc2
1Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden olivia.brunell@kbh.uu.se.
Objective:
To investigate the effect of a quality improvement (QI) package on patient satisfaction of perinatal care.
Design:
Secondary analysis of a stepped-wedge cluster-randomised controlled trial. Participating hospitals were randomised by size into four different wedges.
Setting:
12 secondary-level public hospitals in Nepal.
Participants:
Women who gave birth in the hospitals at a gestational age of ≥22 weeks, with fetal heart sound at admission. Adverse outcomes were excluded. One hospital was excluded due to data incompleteness and four low-volume hospitals due to large heterogeneity. The final analysis included 54 919 women.
Intervention:
Hospital management was engaged and facilitators were recruited from within hospitals. Available perinatal care was assessed in each hospital, followed by a bottle-neck analysis workshop. A 3-day training in essential newborn care was carried out for health workers involved in perinatal care, and a set of QI tools were introduced to be used in everyday practice (skill-checks, self-assessment checklists, scoreboards and weekly Plan-Do-Study-Act meetings). Refresher training after 6 months.
Outcome Measure:
Women's satisfaction with care during childbirth (a prespecified secondary outcome).
Results:
The likelihood of women being overall satisfied with care during childbirth increased after the intervention (adjusted OR (aOR): 1.66, 95% CI: 1.59 to 1.73). However, the proportions of overall satisfaction were low (control 58%, intervention 62%). Women were more likely to be satisfied with education and information from health workers after intervention (aOR: 1.34, 95% CI: 1.29 to 1.40) and to have been treated with dignity and respect (aOR: 1.81, 95% CI: 1.52 to 2.16). The likelihood of having experienced abuse during the hospital stay decreased (aOR: 0.42, 95% CI: 0.34 to 0.51) and of being satisfied with the level of privacy increased (aOR: 1.14, 95% CI: 1.09 to 1.18).
Conclusions:
Improvements in patient satisfaction were indicated after the introduction of a QI-package on perinatal care. We recommend further studies on which aspects of care are most important to improve women's satisfaction of perinatal care in hospitals in Nepal.
Trial Registration Number:
ISRCTN30829654.
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