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Title: Applying the Maternal Near Miss Approach for the Evaluation of Quality of Obstetric Care: A Worked Example from a Multicenter Surveillance Study
Authors: Haddad, Samira Maerrawi
Cecatti, Jose Guilherme
Souza, Joao Paulo
Sousa, Maria Helena
Parpinelli, Mary Angela
Costa, Maria Laura
Pacagnella, Rodolfo C.
Brum, Ione R.
Moraes Filho, Olimpio B.
Feitosa, Francisco E.
Menezes, Carlos A.
Guanabara, Everardo M.
Moreira, Joaquim L.
Peret, Frederico A.
Schmaltz, Luiza E.
Katz, Leila
Barbosa Lima, Antonio C.
Amorim, Melania M.
Martins, Marilia G.
Nascimento, Denis J.
Paiva, Claudio S.
Rohloff, Roger D.
Costa, Sergio M.
Luz, Adriana G.
Lobato, Gustavo
Cordioli, Eduardo
Peracoli, Jose C.
Maia Filho, Nelson L.
Quintana, Silvana M.
Lotufo, Fatima A.
Andreucci, Carla B.
Aquino, Marcia M.
Mattar, Rosiane [UNIFESP]
Universidade Estadual de Campinas (UNICAMP)
Ctr Res Reprod Hlth Campinas Cemicamp
Univ Fed Amazonas
Sch Med Sci
Univ Fed Ceara
Universidade Federal da Bahia (UFBA)
Hosp Geral Cesar Cals
Hosp Geral Fortaleza
Maternidade Odete Valadares
Hosp Materno Infantil
Inst Materno Infantil Pernambuco
Universidade Federal de Pernambuco (UFPE)
Univ Fed Campina Grande
Univ Fed Maranhao
Univ Fed Parana
Univ Fed Paraiba
Hosp Maternidade Fernando Magalhaes
Univ Fed Rio Grande do Sul
Hosp Maternidade Celso Pierro
Inst Fernandes Figueira Fiocruz
Hosp Israelita Albert Einstein
Universidade de São Paulo (USP)
Jundiai Sch Med
Santa Casa Limeira
Santa Casa Sao Carlos
Maternidade Leonor Mendes de Barros
Universidade Federal de São Paulo (UNIFESP)
Issue Date: 1-Jan-2014
Publisher: Hindawi Publishing Corporation
Citation: Biomed Research International. New York: Hindawi Publishing Corporation, 10 p., 2014.
Abstract: Objective. To assess quality of care of women with severe maternal morbidity and to identify associated factors. Method. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. the expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed. Results. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase in maternal mortality ratio, the main factors associated with nonadequate performance were geographic difficulty in accessing health services (P < 0.001), delays related to quality of medical care (P = 0.012), absence of blood derivatives (P = 0.013), difficulties of communication between health services (P = 0.004), and any delay during the whole process (P = 0.039). Conclusions. This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. in this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care.
ISSN: 2314-6133
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