Effect of a multifaceted intervention with audit and feedback on low-risk childbirth practice: a multicentre...

Care for low-risk childbirths constitutes a large proportion of deliveries and is highly influenced by factors such as region, birthing facilities, and health care providers. Audit and feedback as a quality indicator (QI) intervention alone have limited effectiveness. Multidisciplinary approaches, including QI and organizational development, are reportedly effective; however, the impact on low-risk childbirth care remains unclear. We aimed to assess the impact of multifaceted intervention, including audit and feedback, on improving care for low-risk childbirths using QIs.

We conducted a 1-year pre-post comparison targeting healthy pregnant women in four obstetric wards in Japan. The intervention included audit and feedback combined with multifaceted approaches, improvement efforts by a multidisciplinary team, and educational training on health care quality and organizational culture. The outcomes were 12 QIs. The main analysis used interrupted time-series analysis over 6 months pre- and post-intervention. We compared the 9 months pre-intervention with 3 months post-intervention in secondary analysis to assess delayed effects.

We included 288 women pre-intervention and 167 women post-intervention. "The spontaneous vaginal delivery indicator showed a significant increase in slope (risk ratio [RR] 1∙08, 95% confidence interval [CI]: 1∙00-1∙16, p < 0∙05), indicating a trend-based improvement rather than an immediate change per month in the main analysis. Secondary analysis showed a significant increase in the administration of uterotonic agents during the third stage of labour (RR 1∙19, 95% CI: 1∙01-1∙41, p < 0∙05).

The improvement effects of multifaceted interventions, including audit and feedback, using QIs for low-risk childbirths were limited. However, some indicators may improve over time, suggesting a potential delayed effect.

Not applicable.