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Maharashtra
govt develops indicators to assess quality of care
Soumya
Viswanathan - Mumbai
The
Govt of Maharashtra, under the Maharashtra Health Systems
Development Project (MHSDP) has developed clinical indicators
to assess the quality of care delivered in rural Maharashtra
so as to improve the system.
Clinical indicators like perinatal mortality and pre-op
ALOS, which are determinants of quality of care, have
been derived in association with the Tata Institute
of Social Sciences (TISS). Dr Raju Jotkar, asst director,
MHSDP, clarifies that the exercise is not to bring in
punitive measures but to rationalise provider behaviour
and quality. Now that the study is over, next on agenda
is training of officials to carry out regular performance
audit March onwards, when it would be implemented.
| Evaluating
post C-section vaginal births |
| Indicator:
Post C-section vaginal births. That is, percentage
of patients with single previous lower segment C-section
which deliver vaginally. |
| Rationale
: ACOG has recommended that women with previous
low transverse incision be encouraged to attempt
vaginal delivery after considering maternal and
fetal risk. |
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Indicator
value: total number of vaginal births in cases
of previous single LSCS/ total cases of previous
single LSCS x 100 Interpretation: Higher value
is better.
(Source: MHSDP)
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MHSDP
has shortlisted 15 indicators for district hospitals
and 5 for rural hospitals. The indicators will serve
to assess quality of healthcare delivery at 136 hospitals
falling under MHSDP in 33 districts (See Box). The WHO
funded project’s aim is to improve performance
through institutional and policy reforms.
TISS started the “Developing clinical indicators”
project, as it was called, by conducting a baseline
survey in district, sub district and rural hospitals
of Maharashtra to pick more than 100 indicators. Shortlisting
these began with collection of data and its analysis
to determine reliability of data elements and usefulness
of the indicator.
A framework to assess data was prepared based on Canadian
Accreditation System. The process included collection
of data, determining its reliability, analysis and interpretation,
determination of usefulness of indicator information
and continuous monitoring. After brainstorming with
the MHSDP, indictors were brought down to 32 district
and 13 rural indicators. Next was pilot projects carried
out in 2 district and 2 rural hospitals after which
a total of twenty clinical indicators were shortlisted
based on the indicator usefulness score and data reliability
score.
Previously, the only indictors existing were “Left
against medical advice” and “Percentage of
C-sections after normal delivery.” The other performance
indicators did not serve to measure quality of healthcare
delivery. Says Dr Harshad Thakur, prof, health services
studies dept, TISS, “This was a unique project
for us because no other state has developed so many
quality indicators.” It is learnt that Maharashtra
is now sharing its experiences with UP and AP governments,
who are also attempting to develop clinical indicators.
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