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Health care provider decision-making and the quality of maternity care: An analysis of postpartum care in Kenyan hospitals

Evidence suggests that health care providers' non-adherence to clinical guidelines is widespread and contributes to poor patient outcomes across low- and middle-income countries. Through observations of maternity care in Kenya, we found limited adherence to guideline-recommended active monitori...

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Autores principales: Han, Dan, Clarke-Deelder, Emma, Miller, Nora, Opondo, Kennedy, Burke, Thomas, Oguttu, Monica, McConnell, Margaret, Cohen, Jessica
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Pergamon 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10410252/
https://www.ncbi.nlm.nih.gov/pubmed/37450989
http://dx.doi.org/10.1016/j.socscimed.2023.116071
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author Han, Dan
Clarke-Deelder, Emma
Miller, Nora
Opondo, Kennedy
Burke, Thomas
Oguttu, Monica
McConnell, Margaret
Cohen, Jessica
author_facet Han, Dan
Clarke-Deelder, Emma
Miller, Nora
Opondo, Kennedy
Burke, Thomas
Oguttu, Monica
McConnell, Margaret
Cohen, Jessica
author_sort Han, Dan
collection PubMed
description Evidence suggests that health care providers' non-adherence to clinical guidelines is widespread and contributes to poor patient outcomes across low- and middle-income countries. Through observations of maternity care in Kenya, we found limited adherence to guideline-recommended active monitoring of patients for signs of postpartum hemorrhage, the leading cause of maternal mortality, despite providers' having the necessary training and equipment. Using survey vignettes conducted with 144 maternity providers, we documented evidence consistent with subjective risk and perceived uncertainty driving providers' decisions to actively monitor patients. Motivated by these findings, we introduced a simple model of providers' decision-making about whether to monitor a patient, which may depend on their perceptions of risk, diagnostic uncertainty, and the value of new information. The model highlights key trade-offs between gathering diagnostic information through active monitoring versus waiting for signs and symptoms of hemorrhage to manifest. Our work provides a template for understanding provider decision-making and could inform interventions to encourage more proactive obstetric care.
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spelling pubmed-104102522023-08-10 Health care provider decision-making and the quality of maternity care: An analysis of postpartum care in Kenyan hospitals Han, Dan Clarke-Deelder, Emma Miller, Nora Opondo, Kennedy Burke, Thomas Oguttu, Monica McConnell, Margaret Cohen, Jessica Soc Sci Med Article Evidence suggests that health care providers' non-adherence to clinical guidelines is widespread and contributes to poor patient outcomes across low- and middle-income countries. Through observations of maternity care in Kenya, we found limited adherence to guideline-recommended active monitoring of patients for signs of postpartum hemorrhage, the leading cause of maternal mortality, despite providers' having the necessary training and equipment. Using survey vignettes conducted with 144 maternity providers, we documented evidence consistent with subjective risk and perceived uncertainty driving providers' decisions to actively monitor patients. Motivated by these findings, we introduced a simple model of providers' decision-making about whether to monitor a patient, which may depend on their perceptions of risk, diagnostic uncertainty, and the value of new information. The model highlights key trade-offs between gathering diagnostic information through active monitoring versus waiting for signs and symptoms of hemorrhage to manifest. Our work provides a template for understanding provider decision-making and could inform interventions to encourage more proactive obstetric care. Pergamon 2023-08 /pmc/articles/PMC10410252/ /pubmed/37450989 http://dx.doi.org/10.1016/j.socscimed.2023.116071 Text en © 2023 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Han, Dan
Clarke-Deelder, Emma
Miller, Nora
Opondo, Kennedy
Burke, Thomas
Oguttu, Monica
McConnell, Margaret
Cohen, Jessica
Health care provider decision-making and the quality of maternity care: An analysis of postpartum care in Kenyan hospitals
title Health care provider decision-making and the quality of maternity care: An analysis of postpartum care in Kenyan hospitals
title_full Health care provider decision-making and the quality of maternity care: An analysis of postpartum care in Kenyan hospitals
title_fullStr Health care provider decision-making and the quality of maternity care: An analysis of postpartum care in Kenyan hospitals
title_full_unstemmed Health care provider decision-making and the quality of maternity care: An analysis of postpartum care in Kenyan hospitals
title_short Health care provider decision-making and the quality of maternity care: An analysis of postpartum care in Kenyan hospitals
title_sort health care provider decision-making and the quality of maternity care: an analysis of postpartum care in kenyan hospitals
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10410252/
https://www.ncbi.nlm.nih.gov/pubmed/37450989
http://dx.doi.org/10.1016/j.socscimed.2023.116071
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