Effect of a multifaceted intervention with audit and feedback on low-risk childbirth practice: a multicentre prospective study
Abstract Background Care for low-risk childbirths constitutes a large proportion of deliveries and is highly influenced by factors such as region, birthing facilities, and health care providers. Audit and feedback as a quality indicator (QI) intervention alone have limited effectiveness. Multidiscip...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-05-01
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| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12884-025-07681-2 |
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| Summary: | Abstract Background Care for low-risk childbirths constitutes a large proportion of deliveries and is highly influenced by factors such as region, birthing facilities, and health care providers. Audit and feedback as a quality indicator (QI) intervention alone have limited effectiveness. Multidisciplinary approaches, including QI and organizational development, are reportedly effective; however, the impact on low-risk childbirth care remains unclear. We aimed to assess the impact of multifaceted intervention, including audit and feedback, on improving care for low-risk childbirths using QIs. Methods We conducted a 1-year pre–post comparison targeting healthy pregnant women in four obstetric wards in Japan. The intervention included audit and feedback combined with multifaceted approaches, improvement efforts by a multidisciplinary team, and educational training on health care quality and organizational culture. The outcomes were 12 QIs. The main analysis used interrupted time-series analysis over 6 months pre- and post-intervention. We compared the 9 months pre-intervention with 3 months post-intervention in secondary analysis to assess delayed effects. Results We included 288 women pre-intervention and 167 women post-intervention. “The spontaneous vaginal delivery indicator showed a significant increase in slope (risk ratio [RR] 1∙08, 95% confidence interval [CI]: 1∙00–1∙16, p < 0∙05), indicating a trend-based improvement rather than an immediate change per month in the main analysis. Secondary analysis showed a significant increase in the administration of uterotonic agents during the third stage of labour (RR 1∙19, 95% CI: 1∙01–1∙41, p < 0∙05). Conclusion The improvement effects of multifaceted interventions, including audit and feedback, using QIs for low-risk childbirths were limited. However, some indicators may improve over time, suggesting a potential delayed effect. Trial registration Not applicable. |
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| ISSN: | 1471-2393 |