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“Quality of prenatal and maternal care: bridging the know-do gap” (QUALMAT study): an electronic clinical decision support system for rural Sub-Saharan Africa

Identifieur interne : 000223 ( Pmc/Curation ); précédent : 000222; suivant : 000224

“Quality of prenatal and maternal care: bridging the know-do gap” (QUALMAT study): an electronic clinical decision support system for rural Sub-Saharan Africa

Auteurs : Antje Blank [Allemagne] ; Helen Prytherch [Allemagne] ; Jens Kaltschmidt [Allemagne] ; Andreas Krings [Allemagne] ; Felix Sukums [Allemagne, Tanzanie] ; Nathan Mensah [Allemagne, Ghana] ; Alphonse Zakane [Burkina Faso, Suède] ; Svetla Loukanova [Allemagne] ; Lars L. Gustafsson [Suède] ; Rainer Sauerborn [Allemagne] ; Walter E. Haefeli [Allemagne]

Source :

RBID : PMC:3637082

Abstract

Background

Despite strong efforts to improve maternal care, its quality remains deficient in many countries of Sub-Saharan Africa as persistently high maternal mortality rates testify. The QUALMAT study seeks to improve the performance and motivation of rural health workers and ultimately quality of primary maternal health care services in three African countries Burkina Faso, Ghana, and Tanzania. One major intervention is the introduction of a computerized Clinical Decision Support System (CDSS) for rural primary health care centers to be used by health care workers of different educational levels.

Methods

A stand-alone, java-based software, able to run on any standard hardware, was developed based on assessment of the health care situation in the involved countries. The software scope was defined and the final software was programmed under consideration of test experiences. Knowledge for the decision support derived from the World Health Organization (WHO) guideline “Pregnancy, Childbirth, Postpartum and Newborn Care; A Guide for Essential Practice”.

Results

The QUALMAT CDSS provides computerized guidance and clinical decision support for antenatal care, and care during delivery and up to 24 hours post delivery. The decision support is based on WHO guidelines and designed using three principles: (1) Guidance through routine actions in maternal and perinatal care, (2) integration of clinical data to detect situations of concern by algorithms, and (3) electronic tracking of peri- and postnatal activities. In addition, the tool facilitates patient management and is a source of training material. The implementation of the software, which is embedded in a set of interventions comprising the QUALMAT study, is subject to various research projects assessing and quantifying the impact of the CDSS on quality of care, the motivation of health care staff (users) and its health economic aspects. The software will also be assessed for its usability and acceptance, as well as for its influence on workflows in the rural setting of primary health care in the three countries involved.

Conclusion

The development and implementation of a CDSS in rural primary health care centres presents challenges, which may be overcome with careful planning and involvement of future users at an early stage. A tailored software with stable functionality should offer perspectives to improve maternal care in resource-poor settings.

Trial registration

http://www.clinicaltrials.gov/NCT01409824.


Url:
DOI: 10.1186/1472-6947-13-44
PubMed: 23574764
PubMed Central: 3637082

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PMC:3637082

Le document en format XML

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<affiliation wicri:level="1">
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<title>Background</title>
<p>Despite strong efforts to improve maternal care, its quality remains deficient in many countries of Sub-Saharan Africa as persistently high maternal mortality rates testify. The QUALMAT study seeks to improve the performance and motivation of rural health workers and ultimately quality of primary maternal health care services in three African countries Burkina Faso, Ghana, and Tanzania. One major intervention is the introduction of a computerized Clinical Decision Support System (CDSS) for rural primary health care centers to be used by health care workers of different educational levels.</p>
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<sec>
<title>Methods</title>
<p>A stand-alone, java-based software, able to run on any standard hardware, was developed based on assessment of the health care situation in the involved countries. The software scope was defined and the final software was programmed under consideration of test experiences. Knowledge for the decision support derived from the World Health Organization (WHO) guideline “Pregnancy, Childbirth, Postpartum and Newborn Care; A Guide for Essential Practice”.</p>
</sec>
<sec>
<title>Results</title>
<p>The QUALMAT CDSS provides computerized guidance and clinical decision support for antenatal care, and care during delivery and up to 24 hours post delivery. The decision support is based on WHO guidelines and designed using three principles: (1) Guidance through routine actions in maternal and perinatal care, (2) integration of clinical data to detect situations of concern by algorithms, and (3) electronic tracking of peri- and postnatal activities. In addition, the tool facilitates patient management and is a source of training material. The implementation of the software, which is embedded in a set of interventions comprising the QUALMAT study, is subject to various research projects assessing and quantifying the impact of the CDSS on quality of care, the motivation of health care staff (users) and its health economic aspects. The software will also be assessed for its usability and acceptance, as well as for its influence on workflows in the rural setting of primary health care in the three countries involved.</p>
</sec>
<sec>
<title>Conclusion</title>
<p>The development and implementation of a CDSS in rural primary health care centres presents challenges, which may be overcome with careful planning and involvement of future users at an early stage. A tailored software with stable functionality should offer perspectives to improve maternal care in resource-poor settings.</p>
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<sec>
<title>Trial registration</title>
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<ext-link ext-link-type="uri" xlink:href="http://www.clinicaltrials.gov/NCT01409824">http://www.clinicaltrials.gov/NCT01409824</ext-link>
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<pmc article-type="other" xml:lang="en">
<pmc-dir>properties open_access</pmc-dir>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">BMC Med Inform Decis Mak</journal-id>
<journal-id journal-id-type="iso-abbrev">BMC Med Inform Decis Mak</journal-id>
<journal-title-group>
<journal-title>BMC Medical Informatics and Decision Making</journal-title>
</journal-title-group>
<issn pub-type="epub">1472-6947</issn>
<publisher>
<publisher-name>BioMed Central</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">23574764</article-id>
<article-id pub-id-type="pmc">3637082</article-id>
<article-id pub-id-type="publisher-id">1472-6947-13-44</article-id>
<article-id pub-id-type="doi">10.1186/1472-6947-13-44</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Correspondence</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>“Quality of prenatal and maternal care: bridging the know-do gap” (QUALMAT study): an electronic clinical decision support system for rural Sub-Saharan Africa</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes" id="A1">
<name>
<surname>Blank</surname>
<given-names>Antje</given-names>
</name>
<xref ref-type="aff" rid="I1">1</xref>
<email>antje.blank@med.uni-heidelberg.de</email>
</contrib>
<contrib contrib-type="author" id="A2">
<name>
<surname>Prytherch</surname>
<given-names>Helen</given-names>
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<xref ref-type="aff" rid="I2">2</xref>
<email>helen.prytherch@yahoo.com</email>
</contrib>
<contrib contrib-type="author" id="A3">
<name>
<surname>Kaltschmidt</surname>
<given-names>Jens</given-names>
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<xref ref-type="aff" rid="I1">1</xref>
<email>jens.kaltschmidt@med.uni-heidelberg.de</email>
</contrib>
<contrib contrib-type="author" id="A4">
<name>
<surname>Krings</surname>
<given-names>Andreas</given-names>
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<xref ref-type="aff" rid="I1">1</xref>
<email>andreas.krings@med.uni-heidelberg.de</email>
</contrib>
<contrib contrib-type="author" id="A5">
<name>
<surname>Sukums</surname>
<given-names>Felix</given-names>
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<xref ref-type="aff" rid="I1">1</xref>
<xref ref-type="aff" rid="I3">3</xref>
<email>sukums@gmail.com</email>
</contrib>
<contrib contrib-type="author" id="A6">
<name>
<surname>Mensah</surname>
<given-names>Nathan</given-names>
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<xref ref-type="aff" rid="I1">1</xref>
<xref ref-type="aff" rid="I4">4</xref>
<email>mensahnathan@yahoo.com</email>
</contrib>
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<name>
<surname>Zakane</surname>
<given-names>Alphonse</given-names>
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<xref ref-type="aff" rid="I5">5</xref>
<xref ref-type="aff" rid="I6">6</xref>
<email>al_zakane@yahoo.fr</email>
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<surname>Loukanova</surname>
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<xref ref-type="aff" rid="I2">2</xref>
<email>svetla.loukanova@urz.uni-heidelberg.de</email>
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<name>
<surname>Gustafsson</surname>
<given-names>Lars L</given-names>
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<xref ref-type="aff" rid="I6">6</xref>
<email>lars-l.gustafsson@ki.se</email>
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<contrib contrib-type="author" id="A10">
<name>
<surname>Sauerborn</surname>
<given-names>Rainer</given-names>
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<xref ref-type="aff" rid="I2">2</xref>
<email>rainer.sauerborn@med.uni-heidelberg.de</email>
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<contrib contrib-type="author" id="A11">
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<given-names>Walter E</given-names>
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<email>walter.emil.haefeli@med.uni-heidelberg.de</email>
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</contrib-group>
<aff id="I1">
<label>1</label>
Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, D - 69120, Germany</aff>
<aff id="I2">
<label>2</label>
Department of Public Health, University of Heidelberg, Im Neuenheimer Feld 327, Heidelberg, D - 69120, Germany</aff>
<aff id="I3">
<label>3</label>
Muhimbili University of Health and Allied Sciences (MUHAS), Directorate of Information and Communication Technology, P.O. Box 65001, Dar Es Salaam, TZ, Tanzania</aff>
<aff id="I4">
<label>4</label>
Navrongo Health Research Centre, P.O. Box 114, Navrongo, GH, Ghana</aff>
<aff id="I5">
<label>5</label>
Centre de Recherche en Santé de Nouna (CRSN), Nouna, BF, BP 02, Burkina Faso</aff>
<aff id="I6">
<label>6</label>
Department of Laboratory Medicine (LABMED), Division of Clinical Pharmacology (C1:68), Karolinska Institutet, Karolinska University Hospital, Stockholm, SE-141 86, Sweden</aff>
<pub-date pub-type="collection">
<year>2013</year>
</pub-date>
<pub-date pub-type="epub">
<day>10</day>
<month>4</month>
<year>2013</year>
</pub-date>
<volume>13</volume>
<fpage>44</fpage>
<lpage>44</lpage>
<history>
<date date-type="received">
<day>14</day>
<month>8</month>
<year>2012</year>
</date>
<date date-type="accepted">
<day>4</day>
<month>4</month>
<year>2013</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright © 2013 Blank et al.; licensee BioMed Central Ltd.</copyright-statement>
<copyright-year>2013</copyright-year>
<copyright-holder>Blank et al.; licensee BioMed Central Ltd.</copyright-holder>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0">
<license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (
<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0">http://creativecommons.org/licenses/by/2.0</ext-link>
), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<self-uri xlink:href="http://www.biomedcentral.com/1472-6947/13/44"></self-uri>
<abstract>
<sec>
<title>Background</title>
<p>Despite strong efforts to improve maternal care, its quality remains deficient in many countries of Sub-Saharan Africa as persistently high maternal mortality rates testify. The QUALMAT study seeks to improve the performance and motivation of rural health workers and ultimately quality of primary maternal health care services in three African countries Burkina Faso, Ghana, and Tanzania. One major intervention is the introduction of a computerized Clinical Decision Support System (CDSS) for rural primary health care centers to be used by health care workers of different educational levels.</p>
</sec>
<sec>
<title>Methods</title>
<p>A stand-alone, java-based software, able to run on any standard hardware, was developed based on assessment of the health care situation in the involved countries. The software scope was defined and the final software was programmed under consideration of test experiences. Knowledge for the decision support derived from the World Health Organization (WHO) guideline “Pregnancy, Childbirth, Postpartum and Newborn Care; A Guide for Essential Practice”.</p>
</sec>
<sec>
<title>Results</title>
<p>The QUALMAT CDSS provides computerized guidance and clinical decision support for antenatal care, and care during delivery and up to 24 hours post delivery. The decision support is based on WHO guidelines and designed using three principles: (1) Guidance through routine actions in maternal and perinatal care, (2) integration of clinical data to detect situations of concern by algorithms, and (3) electronic tracking of peri- and postnatal activities. In addition, the tool facilitates patient management and is a source of training material. The implementation of the software, which is embedded in a set of interventions comprising the QUALMAT study, is subject to various research projects assessing and quantifying the impact of the CDSS on quality of care, the motivation of health care staff (users) and its health economic aspects. The software will also be assessed for its usability and acceptance, as well as for its influence on workflows in the rural setting of primary health care in the three countries involved.</p>
</sec>
<sec>
<title>Conclusion</title>
<p>The development and implementation of a CDSS in rural primary health care centres presents challenges, which may be overcome with careful planning and involvement of future users at an early stage. A tailored software with stable functionality should offer perspectives to improve maternal care in resource-poor settings.</p>
</sec>
<sec>
<title>Trial registration</title>
<p>
<ext-link ext-link-type="uri" xlink:href="http://www.clinicaltrials.gov/NCT01409824">http://www.clinicaltrials.gov/NCT01409824</ext-link>
.</p>
</sec>
</abstract>
<kwd-group>
<kwd>Guideline adherence</kwd>
<kwd>Clinical decision support systems</kwd>
<kwd>Medical informatics</kwd>
<kwd>Maternal health services</kwd>
<kwd>Pregnancy</kwd>
<kwd>Prenatal care</kwd>
<kwd>Perinatal care</kwd>
<kwd>Millennium development goal</kwd>
<kwd>Motivation by information technology</kwd>
<kwd>Rural maternal healthcare</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
</record>

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