title: Multifaceted intervention to implement indicators of quality of care for severe pre-eclampsia/eclampsia.
abstract: OBJECTIVE
  To assess the acceptability of implementing indicators of quality of care for severe pre-eclampsia/eclampsia to health providers, and to evaluate the effect of a multifaceted intervention on adherence to these indicators.
  
  
  METHODS
  A multifaceted approach was used to implement indicators of quality of care for severe pre-eclampsia/eclampsia that were relevant to both district and referral hospitals. Healthcare providers at 9 hospitals in Southern Thailand rated the acceptability and priority of each indicator. In addition, medical records were reviewed before and after the intervention.
  
  
  RESULTS
  More than 90% of the indicators were considered to be acceptable by the 145 health providers who participated in the study. After the intervention, adherence to most indicators was significantly increased. However, adherence after the intervention was lower than 80% for one-third of the indicators at district hospitals, compared with less than 10% of the indicators at referral hospitals. Common barriers to indicator implementation were lack of resources and skills, difficulty in making early and accurate diagnoses, and management.
  
  
  CONCLUSIONS
  The indicators for the quality of care for severe pre-eclampsia/eclampsia were acceptable. Adherence to the indicators increased through a multifaceted intervention; however, the adherence varied considerably depending on the hospital referral level.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Pattarawalai
authors.initials: P
authors.lastname: Talungchit
authors.affiliation: Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand. Electronic address: ltippawa@hotmail.com.
authors.forename: Tippawan
authors.initials: T
authors.lastname: Liabsuetrakul
authors.affiliation: International Maternal and Child Health, Uppsala University, Uppsala, Sweden.
authors.forename: Gunilla
authors.initials: G
authors.lastname: Lindmark
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D004461:Eclampsia / Q000628:therapy*; D005260:Female; D006761:Hospitals / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D010564:Personnel, Hospital; D011225:Pre-Eclampsia / Q000628:therapy*; D011247:Pregnancy; D019984:Quality Indicators, Health Care; D013785:Thailand
keywords: Acceptability; Adherence; Eclampsia; Indicator; Multifaceted intervention; Priority; Severe pre-eclampsia