Banca de DEFESA: KELIENNY DE MENESES SOUSA

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : KELIENNY DE MENESES SOUSA
DATE: 28/02/2020
TIME: 14:00
LOCAL: Sala de aula 1 do Núcleo de Estudos em Saúde Coletiva (NESC/UFRN).
TITLE:

QUALITY OF OBSTETRIC AND NEONATAL CARE: GOOD PRACTICES, ADVERSE EVENTS AND EFFECTS OF THE WHO SAFE CHILDBIERTH CHECKLIST

KEY WORDS:

Quality of Health Care. Patient Safety. Maternal-Child Health Services. Checklist. Indicators of Health Services.

PAGES: 276
BIG AREA: Ciências da Saúde
AREA: Saúde Coletiva
SUBÁREA: Saúde Pública
SUMMARY:

Introduction: Although it is a physiological event, institutionalized birth is a complex process that often results in unnecessary interventions and harm. To reduce maternal and neonatal morbidity and mortality, which is intrinsically related to quality of care, the World Health Organization (WHO) developed the Safe Birth Checklist. Studies demonstrate their potential effect on improving good practice, but new studies need to assess their impact on adverse events and health outcomes. Objectives: (1) to evaluate and compare adherence to Good Practice (GP) and incidence of Obstetric Adverse Events (AE) in maternity wards in Brazil and Mexico; (2) develop a platform for monitoring childbirth care indicators; (3) analyze the effect of the intervention with the checklist on the quality of care. Method: This is a multicenter research carried out in hospitals in Brazil and Mexico, part of the WHO Safe Childbirth Checklist Collaboration initiative. An uncontrolled quasi-experimental time series design was performed with retrospective analysis of birth records from 2015 to 2016 for 24 successive biweekly measurements and cross-sectional analysis before-after longitudinal measurements. 1,440 deliveries were reviewed in two hospitals in northeastern Brazil and 2,707 in five Mexican hospitals. Chi-square statistics and control graphs were performed to evaluate the performance of the transverse and longitudinal estimates, respectively. The software for collecting, monitoring and analyzing indicators was developed with Information Technology professionals to issue evaluation reports containing descriptive tables and longitudinal and cross-sectional graphs of estimates. Results: Before the implementation of the checklist, a low adherence to BP and a high incidence of AE was identified in institutions in both countries, especially in Brazilian hospitals (26.8% of BP and 16.0% of AE) and those specialized in pregnancy high risk (24.5% BP and 27.2% EA). After the implementation of the checklist in Brazilian services, even with a relatively low level of completion (20.7%), a significant increase (p <0.001) was found in the general compliance with 9 BP recommended by the checklist for the management of hypertensive disorders and of immediate care for mother and baby was 45.4% in the reference period and rose to 49.2% after the intervention (relative improvement of 7.0%; p <0.001). There was also a significant reduction in the rate of deliveries complicated by severe hypertensive disorders, hemorrhage and AS and in the incidence of uterine rupture, obstetric hemorrhage and severe hypertension. The development of the Plataforma QualiParto (in Portuguese) (qualiparto.ccs.ufrn.br) allowed participating services to use a system to monitor and evaluate outcome indicators and care processes of childbirth. Conclusions: The main results of this study (knowledge of the obstetrics GP and AE profile, intervention with checklist and development of technology for quality monitoring allowed the contextual identification and prioritization of interventions for quality improvement and benefited the care of mothers and newborns and the organizational management of services, making obstetric practices safer and more effective.

BANKING MEMBERS:
Externo à Instituição - GILBERTO MARTINS SANTOS - UFSM
Interna - 421717 - MARIA ANGELA FERNANDES FERREIRA
Externa à Instituição - MÔNICA SILVA MARTINS - ENSP
Externo ao Programa - 3578073 - RODRIGO ASSIS NEVES DANTAS
Presidente - 1868020 - ZENEWTON ANDRÉ DA SILVA GAMA