title: Evaluation of the quality of antenatal care using electronic health record information in family medicine clinics of Mexico City.
abstract: BACKGROUND
  Evaluation of the quality of antenatal care (ANC) using indicators should be part of the efforts to improve primary care services in developing countries. The growing use of the electronic health record (EHR) has the potential of making the evaluation more efficient. The objectives of this study were: (a) to develop quality indicators for ANC and (b) to evaluate the quality of ANC using EHR information in family medicine clinics (FMCs) of Mexico City.
  
  
  METHODS
  We used a mixed methods approach including: (a) in-depth interviews with health professionals; (b) development of indicators following the RAND-UCLA method; (c) a retrospective cohort study of quality of care provided to 5342 women aged 12-49 years who had completed their pregnancy in 2009 and attended to at least one ANC visit with their family doctor. The study took place in four FMCs located in Mexico City. The source of information was the EHR. SAS statistical package served for programing and performing the descriptive statistical analysis.
  
  
  RESULTS
  14 ANC quality indicators were developed. The evaluation showed that 40.6% of women began ANC in the first trimester; 63.5% with low-risk pregnancy attended four or more ANC visits; 4.4% were referred for routine obstetric ultrasound, and 41.1% with vaginal infection were prescribed metronidazole. On average, the percentage of recommended care that women received was 32.7%.
  
  
  CONCLUSIONS
  It is feasible to develop quality indicators suitable for evaluating the quality of ANC using routine EHR data. The study identified the ANC areas that require improvement; which can guide future strategies aimed at improving ANC quality.
authors.affiliation: Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, México. svetlana.doubova@gmail.com.
authors.forename: Svetlana V
authors.initials: SV
authors.lastname: Doubova
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pérez-Cuevas
authors.forename: Eduardo
authors.initials: E
authors.lastname: Ortiz-Panozo
authors.forename: Bernardo
authors.initials: B
authors.lastname: Hernández-Prado
mesh_terms: D000293:Adolescent; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002648:Child; D057286:Electronic Health Records; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008795:Metronidazole / Q000627:therapeutic use; D008800:Mexico; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011295:Prenatal Care / Q000592:standards* / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal; D016585:Vaginosis, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents; D008795:Metronidazole