Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2020 Apr 21;32(1):54-63.
doi: 10.1093/intqhc/mzz126.

Did a quality improvement intervention improve quality of maternal health care? Implementation evaluation from a cluster-randomized controlled study

Elysia Larson  1   2 , Godfrey M Mbaruku  3 , Jessica Cohen  1 , Margaret E Kruk  1
Affiliations
Randomized Controlled Trial

Did a quality improvement intervention improve quality of maternal health care? Implementation evaluation from a cluster-randomized controlled study

Elysia Larson et al. Int J Qual Health Care. .

Abstract

Objective: To test the success of a maternal healthcare quality improvement intervention in actually improving quality.

Design: Cluster-randomized controlled study with implementation evaluation; we randomized 12 primary care facilities to receive a quality improvement intervention, while 12 facilities served as controls.

Setting: Four districts in rural Tanzania.

Participants: Health facilities (24), providers (70 at baseline; 119 at endline) and patients (784 at baseline; 886 at endline).

Interventions: In-service training, mentorship and supportive supervision and infrastructure support.

Main outcome measures: We measured fidelity with indictors of quality and compared quality between intervention and control facilities using difference-in-differences analysis.

Results: Quality of care was low at baseline: the average provider knowledge test score was 46.1% (range: 0-75%) and only 47.9% of women were very satisfied with delivery care. The intervention was associated with an increase in newborn counseling (β: 0.74, 95% CI: 0.13, 1.35) but no evidence of change across 17 additional indicators of quality. On average, facilities reached 39% implementation. Comparing facilities with the highest implementation of the intervention to control facilities again showed improvement on only one of the 18 quality indicators.

Conclusions: A multi-faceted quality improvement intervention resulted in no meaningful improvement in quality. Evidence suggests this is due to both failure to sustain a high-level of implementation and failure in theory: quality improvement interventions targeted at the clinic-level in primary care clinics with weak starting quality, including poor infrastructure and low provider competence, may not be effective.

Keywords: Tanzania; cluster-randomized controlled study; implementation science; maternal health; quality improvement; quality measurement.

PubMed Disclaimer

References

    1. Fink G, Ross R, Hill K. Institutional deliveries weakly associated with improved neonatal survival in developing countries: evidence from 192 demographic and health surveys. Int J Epidemiol 2015. PubMed PMID: 26130739. - PubMed
    1. Ng M, Misra A, Diwan V et al. . An assessment of the impact of the JSY cash transfer program on maternal mortality reduction in Madhya Pradesh, India. Glob Health Action 2014;7. - PMC - PubMed
    1. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS et al. . Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the global burden of disease study 2013. Lancet 2014. PubMed PMID: 24797575. - PMC - PubMed
    1. Wang H, Liddell CA, Coates MM et al. . Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the global burden of disease study 2013. Lancet 2014;384:957–79. PubMed PMID: 24797572. Pubmed Central PMCID: 4165626. - PMC - PubMed
    1. World Health Organization Care in normal birth: a practical guide. Technical Working Group. Birth 1997;24:121–3. PubMed PMID: 9271979. - PubMed

Publication types

MeSH terms