Investigating the feasibility of introducing a consolidated birth record : the first step in an information system that identifies outcomes and enables improvement
- Publication Type:
- Thesis
- Issue Date:
- 2005
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| 01Front.pdf | contents and abstract | 828.89 kB | |||
| 02Whole.pdf | thesis | 19.43 MB |
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NO FULL TEXT AVAILABLE. Access is restricted indefinitely. ----- This research project investigated the feasibility of introducing a consolidated birth
record (JCBR) in three hospitals in Jordan, using action research. The project worked to
improve the clinical record and link community and hospital antenatal, birth and
postnatal care, while also providing mothers with a copy of the birth and postnatal data.
The research investigated whether this improved record could be the basis of a system
that allows individual hospitals to analyse and benchmark their care against other
hospitals, provide evidence of best practice and, further, if this could potentially be the
basis of a national monitoring system. The goal was to test whether the JCBR could
inform planning, and demonstrate accountability from the local level to a national
system of monitoring perinatal mortality and morbidity in Jordan and improve clinical
outcomes and organisational efficiency.
The study was an exploratory, descriptive design that used an 'action research'
approach of engaging practitioners with the researcher to investigate the feasibility of
introducing the JCBR in three participating hospitals. The study drew on a combination
of quantitative and qualitative data to compare baseline administrative and clinical data
currently collected with implementation data from the JCBR. Qualitative data were
collected through an action research process that explored doctors', nurses' and
midwives' perceptions of the consolidated birth record as a clinical data collection tool
and the organisational response to implementing the tool. The results report the
potential impact of outcomes for mothers and infants and for health system
improvement, if the JCBR was introduced nationally.
Baseline results of this study showed that recording of birth data in the current hospital
records is of poor quality. Practitioners had no access to antenatal records collected and
stored in community settings, nor was sufficient hospital data returned to the
community setting for informed care after discharge. Data were recorded in 18 different
places in the records. There was much duplication; most items were insufficiently
completed or missed; clinicians often did not report on their own care; this was
completed retrospectively and sometimes by another person; and records were difficult
to access and used only for direct care. There was no peer review of performance and
data were not used for analysis or planning. Baseline results confirmed that pregnant
women, mothers and infants are receiving fragmented care, with no linking among
settings providing the care or among care providers themselves.
The JCBR was implemented over a two-month period in 2004. Two evaluation studies
were completed, one immediately post-implementation and one seven months later.
Results suggest that using the action research process of involving practitioners in the
development and implementation of the JCBR in the three hospitals was successful in
achieving change that was supported and would be sustained. Completion rates of the
JCBR, the accuracy of data recorded in the JCBR, and the commitment of health
professionals to the process of the implementation of the JCBR improved over the time
of the implementation.
Results also suggested that the JCBR could collect important clinical data to assist in
ongoing planning, quality improvement and development of maternity services, as well
as measuring outcomes for individual hospitals and nationally. The JCBR was simple to
use, saved time and effort, facilitated communication between mothers and health
professionals and within the health team itself, provided improved access to important
data about the mother and her infant for health workers, while informing women
themselves, and improving continuity of care.
Results from this study suggest that there is both the potential and commitment
necessary to improve the quality and communication of clinical data. It also seems
feasible to develop an aggregated perinatal data collection system in Jordan based on
the piloted JCBR tested in this study.
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