title: Development and assessment of indicators for quality of care in severe preeclampsia/eclampsia and postpartum hemorrhage.
abstract: Severe preeclampsia/eclampsia and postpartum hemorrhage (PPH) are serious obstetric problems worldwide. Quality improvement of care measured by evidence-based indicators is recommended as a recent important strategy; however, the indicators for quality of care of these two conditions have not been established. This study aimed to develop such indicators and assess their validity, reliability, and feasibility at different contextual levels. Of 32 initially valid indicators for care of severe preeclampsia/eclampsia, after two rounds of Delphi technique, 21 and 30 indicators were agreed to be suitable to monitor care at district and referral hospitals. Of 13 initial indicators for PPH, 8 and 13 indicators were selected, respectively. The interrater reliability of indicators varied from 0.28 to 0.63. At least three-fourths of all indicators rated by local doctors and nurses were assessed as feasible in terms of relevance, measurability, and improvability. The process identified reliable and feasible performance indicators to monitor quality of care in severe preeclampsia/eclampsia and PPH for either basic or comprehensive emergency obstetric care (EmOC). The informative applicability of these indicators in clinical practice needs further evaluation.
authors.affiliation: Maternal and Fetal Medicine Unit, Department of Obstetrics and Gynecology, Siriraj Hospital, Mahidol University, Thailand. siriraj105@yahoo.com
authors.forename: Pattarawalai
authors.initials: P
authors.lastname: Talungchit
authors.forename: Tippawan
authors.initials: T
authors.lastname: Liabsuetrakul
authors.forename: Gunilla
authors.initials: G
authors.lastname: Lindmark
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D032921:Consensus; D003430:Cross-Sectional Studies; D003697:Delphi Technique; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009775:Obstetrics and Gynecology Department, Hospital / Q000592:standards*; D006473:Postpartum Hemorrhage / Q000175:diagnosis / Q000628:therapy*; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000628:therapy*; D011247:Pregnancy; D019984:Quality Indicators, Health Care / Q000458:organization & administration / Q000592:standards*; D015203:Reproducibility of Results; D013785:Thailand; D000078329:Workforce