Developing evidence-based maternity care in Iran: a quality improvement study.
BACKGROUND
Current Iranian perinatal statistics indicate that maternity care continues to need improvement. In response, we implemented a multi-faceted intervention to improve the quality of maternity care at an Iranian Social Security Hospital. Using a before-and-after design our aim was to improve the uptake of selected evidence based practices and more closely attend to identified women's needs and preferences.


METHODS
The major steps of the study were to (1) identify women's needs, values and preferences via interviews, (2) select through a process of professional consensus the top evidence-based clinical recommendations requiring local implementation (3) redesign care based on the selected evidence-based recommendations and women's views, and (4) implement the new care model. We measured the impact of the new care model on maternal satisfaction and caesarean birth rates utilising maternal surveys and medical record audit before and after implementation of the new care model.


RESULTS
Twenty women's needs and requirements as well as ten evidence-based clinical recommendations were selected as a basis for improving care. Following the introduction of the new model of care, women's satisfaction levels improved significantly on 16 of 20 items (p < 0.0001) compared with baseline. Seventy-eight percent of studied women experienced care consistent with the new model and fewer women had a caesarean birth (30% compared with 42% previously).


CONCLUSIONS
The introduction of a quality improvement care model improved compliance with evidence-based guidelines and was associated with an improvement in women's satisfaction levels and a reduction in rates of caesarean birth.
Aghlmand
Siamak
S
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Poursina Avenue, Tehran, 1417613191, Iran. saghlmand@razi.tums.ac.ir
Akbari
Feizollah
F
Lameei
Aboulfath
A
Mohammad
Kazem
K
Small
Rhonda
R
Arab
Mohammad
M
D019317:Evidence-Based Medicine / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D007492:Iran; D008427:Maternal Health Services / Q000379:methods / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D011247:Pregnancy; D011295:Prenatal Care; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires