Applying the maternal near miss approach for the evaluation of quality of obstetric care : a worked example from a multicenter surveillance study

• Autor(a) principal: Haddad, Samira El Maerrawi Tebecherane
• Data de Publicação: 2014
• Outros Autores: Cecatti, Jose Guilherme, Souza, João Paulo Dias de, Sousa, Maria Helena de, Parpinelli, Mary Angela, Nascimento, Maria Laura Costa do, Pacagnella, Rodolfo de Carvalho, Brum, Ione Rodrigues, Moraes Filho, Olimpio Barbosa de, Feitosa, Francisco Edson de Lucena, Menezes, Carlos Augusto Santos de, Guanabara, Everardo de Macedo, Moreira, Joaquim Luiz de Castro, Peret, Frederico Jose Amedee, Schmaltz, Luiza Emylce Pelá Rosado, Katz, Leila, Lima, Antonio Carlos Fernandes Barbosa, Amorim, Melania Maria Ramos de, Martins, Marília da Glória, Nascimento, Dênis José, Paiva, Cláudio Sérgio Medeiros, Rohloff, Roger Dennis, Costa, Sergio Hofmeister de Almeida Martins, Luz, Adriana Gomes, Azevedo, Gustavo Lobato de, Cordioli, Eduardo, Peraçoli, Jose Carlos, Maia Filho, Nelson Lourenço, Quintana, Silvana Maria, Lotufo, Fátima Aparecida Henrique, Polido, Carla Betina Andreucci, Aquino, Marcia Maria Auxiliadora de, Mattar, Rosiane
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UFRGS
• Texto Completo: http://hdl.handle.net/10183/159790
• topic: Complicações na gravidez; Mortalidade materna; Serviços de saúde materna

Objective. To assess quality of care of women with severe maternal morbidity and to identify associated factors. Method. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. The expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed. Results. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase inmaternalmortality ratio, themain factors associated with nonadequate performance were geographic difficulty in accessing health services ( < 0.001), delays related to quality of medical care ( = 0.012), absence of blood derivatives ( = 0.013), difficulties of communication between health services ( = 0.004), and any delay during thewhole process ( = 0.039). Conclusions. This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. In this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care.