The role of digital clinical decision support tool in improving quality of intrapartum and postpartum care: experiences from two states of India
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Authors
Usmanova, Gulnoza
Lalchandani, Kamlesh
Srivastava, Ashish
Joshi, Chandra Shekhar
Bhatt, Deepak Chandra
Bairagi, Anand Kumar
Jain, Yashpal
Afzal, Mohammed
Dhoundiyal, Rashmi
Benawri, Jyoti
Issue Date
2021-04-07
Type
Article
Language
en_US
Keywords
Intrapartum Care , Postpartum Care , Maternal Health , New-born Health , mHealth , Health Information Technology , Quality Improvement
Alternative Title
Abstract
Background:
Computerized clinical decision support (CDSS) –digital information systems designed to improve clinical decision making by providers – is a promising tool for improving quality of care. This study aims to understand the uptake of ASMAN application (defined as completeness of electronic case sheets), the role of CDSS in improving adherence to key clinical practices and delivery outcomes.
Methods:
We have conducted secondary analysis of program data (government data) collected from 81 public facilities across four districts each in two sates of Madhya Pradesh and Rajasthan. The data collected between August –October 2017 (baseline) and the data collected between December 2019 – March 2020 (latest) was analysed. The data sources included: digitized labour room registers, case sheets, referral and discharge summary forms, observation checklist and complication format. Descriptive, univariate and multivariate and interrupted time series regression analyses were conducted.
Results:
The completeness of electronic case sheets was low at postpartum period (40.5%), and in facilities with more than 300 deliveries a month (20.9%). In multivariate logistic regression analysis, the introduction of technology yielded significant improvement in adherence to key clinical practices. We have observed reduction in fresh still births rates and asphyxia, but these results were not statistically significant in interrupted time series analysis. However, our analysis showed that identification of maternal complications has increased over the period of program implementation and at the same time referral outs decreased.
Conclusions:
Our study indicates CDSS has a potential to improve quality of intrapartum care and delivery outcome. Future studies with rigorous study design is required to understand the impact of technology in improving quality of maternity care.
Description
Citation
Usmanova, G., Lalchandani, K., Srivastava, A., Joshi, C. S., Bhatt, D. C., Bairagi, A. K., Jain, Y., Afzal, M., Dhoundiyal, R., Benawri, J., Chaudhary, T., Mishra, A., Wadhwa, R., Sridhar, P., Bahl, N., Gaikwad, P., & Sood, B. (2021). The role of digital clinical decision support tool in improving quality of intrapartum and postpartum care: experiences from two states of India. BMC pregnancy and childbirth, 21(1), 278. https://doi.org/10.1186/s12884-021-03710-y
Publisher
BMC Pregnancy and Childbirth