title: Impact of a nationwide study for surveillance of maternal near-miss on the quality of care provided by participating centers: a quantitative and qualitative approach.
abstract: BACKGROUND
  The Brazilian Network for Surveillance of Severe Maternal Morbidity was established in 27 centers in different regions of Brazil to investigate the frequency of severe maternal morbidity (near-miss and potentially life-threatening conditions) and associated factors, and to create a collaborative network for studies on perinatal health. It also allowed interventions aimed at improving the quality of care in the participating institutions. The objective of this study was to evaluate the perception of the professionals involved regarding the effect of participating in such network on the quality of care provided to women.
  
  
  METHODS
  A mixed quantitative and qualitative study interviewed coordinators, investigators and managers from all the 27 obstetric units that had participated in the network. Following verbal informed consent, data were collected six and twelve months after the surveillance period using structured and semi-structured interviews that were conducted by telephone and recorded. A descriptive analysis for the quantitative and categorical data, and a thematic content analysis for the answers to the open questions were performed.
  
  
  RESULTS
  The vast majority (93%) of interviewees considered it was important to have participated in the network and 95% that their ability to identify cases of severe maternal morbidity had improved. They also considered that the study had a positive effect, leading to changes in how cases were identified, better organization/standardization of team activities, changes in routines/protocols, implementation of auditing for severe cases, dissemination of knowledge at local/regional level and a contribution to local and/or national identification of maternal morbidity. After 12 months, interviewees mentioned the need to improve prenatal care and the scientific importance of the results. Some believed that there had been little or no impact due to the poor dissemination of information and the resistance of professionals to change practice. In this second interview, a lack of systematic surveillance after the end of the study, difficulty in referring cases and changes in the leadership of the unit were mentioned.
  
  
  CONCLUSIONS
  In the opinion of these professionals, participating in a network for the surveillance of severe maternal morbidity represented a good strategy for improving services, even in reference centers.
authors.affiliation: University of Campinas UNICAMP, Campinas, Brazil. adrigoluz@gmail.com.
authors.forename: Adriana Gomes
authors.initials: AG
authors.lastname: Luz
authors.forename: Maria José Duarte
authors.initials: MJ
authors.lastname: Osis
authors.forename: Meire
authors.initials: M
authors.lastname: Ribeiro
authors.forename: José Guilherme
authors.initials: JG
authors.lastname: Cecatti
authors.forename: Eliana
authors.initials: E
authors.lastname: Amaral
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D009017:Morbidity / Q000639:trends; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011295:Prenatal Care / Q000592:standards*; D011787:Quality of Health Care; D012042:Registries; D011795:Surveys and Questionnaires