From the Guidelines
Perinatal Quality Improvement committees examine process measures to evaluate the effect of one step on other things in the process, analyze multiple steps that possibly lead to better maternal and neonatal outcomes, and ultimately assess neonatal and maternal outcomes. The primary goal of these committees is to identify areas for improvement in healthcare delivery systems and clinical practices in maternal and newborn care. They analyze metrics such as adherence to evidence-based protocols, timeliness of interventions, appropriate medication administration, screening rates, and documentation completeness, as these process measures are considered more actionable and can offer clearer insights into desired practice changes 1. According to a recent study published in Implementation Science, process measures were predominantly targeted to assess practice patterns, and a combined approach targeting both process and outcome measures can yield greater improvements and enhance the effectiveness of feedback interventions 1. Some of the key process measures examined by these committees include:
- Adherence to evidence-based protocols for conditions like hypertensive disorders or postpartum hemorrhage
- Timeliness of interventions, such as antenatal steroid administration for women at risk of preterm birth
- Appropriate medication administration, including the use of magnesium sulfate for neuroprotection and antibiotics for Group B Streptococcus prophylaxis
- Screening rates and documentation completeness, which are critical for identifying gaps in care delivery and standardizing clinical practices By monitoring these process measures, committees can identify areas for improvement, standardize clinical practices, reduce unnecessary variations in care, and ultimately improve maternal and neonatal outcomes, as supported by recent findings that 68% of studies using process measures and 79% of studies incorporating both process and outcome measures reported improvements 1.
From the Research
Perinatal Quality Improvement Committees
Perinatal Quality Improvement committees examine process measures to evaluate:
- The effect of one step on other things in the process
- Multiple steps that possibly lead to better maternal and neonatal outcomes
- Neonatal and maternal outcomes
Evaluation of Process Measures
The evaluation of process measures is crucial in improving the quality of perinatal care. According to 2, State Perinatal Quality Collaboratives (PQCs) play a significant role in scaling up quality improvement efforts for reducing maternal mortality and severe maternal morbidity. The choice of measures is also explored, highlighting the importance of selecting the right metrics to evaluate process measures.
Tools and Methods for Quality Improvement
Various tools and methods are used for quality improvement and patient safety in perinatal care, including the Model for Improvement, Six Sigma, and Lean 3. These frameworks and tools help manage the complex process of improving care and can be applied to evaluate process measures.
Quality Improvement Interventions
Quality improvement interventions can lead to significant improvements in maternal and neonatal care. A study in India found that a quality improvement intervention resulted in improved care for eight of the nine process elements, with a significant decline in perinatal mortality 4. This highlights the importance of evaluating process measures to identify areas for improvement.
Perinatal Quality Collaboratives
Perinatal quality collaboratives are networks of perinatal care providers working to improve pregnancy outcomes for women and newborns through continuous quality improvement 5. These collaboratives identify processes of care that require improvement and use the best available methods to effect change and improve outcomes.
Composite Index for Quality of Care
A composite index can be used to evaluate the quality of maternal obstetric and neonatal healthcare in low-income countries 6. This index can be developed using a step-wise approach and can provide a comprehensive measure of quality of care, reflecting the multi-dimensional nature of maternal and newborn care.