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Multicenter Study
. 2014:2014:989815.
doi: 10.1155/2014/989815. Epub 2014 Jul 24.

Applying the maternal near miss approach for the evaluation of quality of obstetric care: a worked example from a Multicenter Surveillance Study

Samira Maerrawi Haddad  1 , Jose Guilherme Cecatti  2 , Joao Paulo Souza  1 , Maria Helena Sousa  3 , Mary Angela Parpinelli  1 , Maria Laura Costa  1 , Rodolfo C Pacagnella  1 , Ione R Brum  4 , Olímpio B Moraes Filho  5 , Francisco E Feitosa  6 , Carlos A Menezes  7 , Everardo M Guanabara  8 , Joaquim L Moreira  9 , Frederico A Peret  10 , Luiza E Schmaltz  11 , Leila Katz  12 , Antonio C Barbosa Lima  13 , Melania M Amorim  14 , Marilia G Martins  15 , Denis J Nascimento  16 , Cláudio S Paiva  17 , Roger D Rohloff  18 , Sergio M Costa  19 , Adriana G Luz  20 , Gustavo Lobato  21 , Eduardo Cordioli  22 , Jose C Peraçoli  23 , Nelson L Maia Filho  24 , Silvana M Quintana  25 , Fátima A Lotufo  26 , Carla B Andreucci  27 , Márcia M Aquino  28 , Rosiane Mattar  29
Affiliations
Multicenter Study

Applying the maternal near miss approach for the evaluation of quality of obstetric care: a worked example from a Multicenter Surveillance Study

Samira Maerrawi Haddad et al. Biomed Res Int. 2014.

Abstract

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 in maternal mortality ratio, the main factors associated with nonadequate performance were geographic difficulty in accessing health services (P < 0.001), delays related to quality of medical care (P = 0.012), absence of blood derivatives (P = 0.013), difficulties of communication between health services (P = 0.004), and any delay during the whole process (P = 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.

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Figures

Figure 1
Figure 1
SMR calculator.
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