A4：临床实践中的突破性改进.pdf

1、22nd May 2025Unravelling What Works to Increase C-Sections in Bihar,IndiaDr.Abha Mehndiratta,Faculty&Improvement Advisor,Institute for Healthcare ImprovementDeclaration of Interests The improvement initiative was supported by the Government of Bihar(GoB)and development partners(Institute for Healthc

2、are Improvement(IHI)and CARE India).The GoB provided essential resources for maternal and newborn care to the district hospitals.Medical staff from participating hospitals were all recruited and paid for by the Government of Bihar and were not financially incentivised to undertake this work.The prov

3、ision of services for the population was entirely funded by the State of Bihar,and no insurance schemes were active for this population at the time.The Government of Bihar also provided comparative data on percentage of C-section deliveries for the remaining 26 district hospitals that were not inclu

4、ded in the QI collaborative.The technical assistance provided by IHI and CARE India was funded by the Bill and Melinda Gates FoundationAbha Mehndiratta et al.BMJ Qual Saf 2025;34:404-412Take Home Messages QI plus resources(vs QI alone or resources alone)are required interventions to effect change in

5、 poor resource settings.Context-sensitive collaborative approach for QI,in collaboration with local government,is an effective method to increase C-sections.The use of counterfactuals(non-QI hospitals)and time series data was critical to attributing the observed increase in C-section ratesAbha Mehnd

6、iratta et al.BMJ Qual Saf 2025;34:404-412Background Setting the Context3rd most populous state in India-130 million peopleBihar Maternal Mortality Ration(MMR)was 149/100,000 live births Vs National Average of 113/100,000(2016-2018)8 Feb 2018Leadership meeting Feb 2018QI Capability Workshop 1QI Capab