Practices for planned birth among women with low-risk pregnancies vary by birth setting, medical professional, and organizational system. Appropriate monitoring is essential for quality improvement. Although sets of quality indicators have been developed, their applicability has not been tested. To improve the quality of childbirth care for low-risk mothers and infants in Japanese hospitals, we developed 35 quality indicators using existing clinical guidelines and quality indicators. We retrospectively analysed data for 347 women in Japan diagnosed with low-risk pregnancy in the second trimester, admitted between April 2015 and March 2016. We obtained scores for 35 quality indicators and evaluated their applicability, i.e., feasibility, improvement potential, and reliability (intra- and inter-rater reliability: kappa score, positive and negative agreement). The range of adherence to each indicator was 0-95.7%. We identified feasibility concerns for six indicators with over 25% missing data. Two indicators with over 90% adherence showed limited potential for improvement. Three indicators had poor kappa scores for intra-rater reliability, with positive/negative agreement scores 0.94/0.33, 0.33/0.95, and 0.00/0.97, respectively. Two indicators had poor kappa scores for inter-rater reliability, with positive/negative agreement scores 0.25/0.92 and 0.68/0.61, respectively. The findings indicated that these 35 care quality indicators for low-risk pregnant women may be applicable to real-world practice, with some caveats.

译文

低风险怀孕妇女的计划生育做法因出生环境,医疗专业人员和组织系统而异。适当的监控对于质量改进至关重要。尽管已经开发了质量指标集,但尚未对其适用性进行测试。为了提高日本医院低危母婴的分娩护理质量,我们使用现有的临床指南和质量指标制定了35项质量指标。我们回顾性分析了日本347名在2015年4月和2016年3月之间被诊断为妊娠中期低风险妊娠的妇女的数据。我们获得了35个质量指标的分数,并评估了它们的适用性,即可行性、改进潜力和可靠性 (评分者内和评分者间的可靠性: kappa评分,积极和消极一致)。每个指标的依从性范围为0-95.7%。我们确定了六个指标的可行性问题,其中有25% 多个数据缺失。遵守超过90% 的两个指标显示出有限的改进潜力。三个指标的评分员内信度kappa评分较差,阳性/阴性一致性得分分别为0.94/0.33,0.33/0.95和0.00/0.97。两个指标的评分员间信度kappa评分较差,阳性/阴性一致性得分分别为0.25/0.92和0.68/0.61。研究结果表明,低风险孕妇的这35项护理质量指标可能适用于现实世界,但有一些警告。

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