Investigating the feasibility of introducing a consolidated birth record : the first step in an information system that identifies outcomes and enables improvement

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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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