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Beyond signal functions in global obstetric care: Using a clinical cascade to measure emergency obstetric readiness

BACKGROUND: Globally, the rate of reduction in delivery-associated maternal and perinatal mortality has been slow compared to improvements in post-delivery mortality in children under five. Improving clinical readiness for basic obstetric emergencies is crucial for reducing facility-based maternal d...

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Autores principales: Cranmer, John N., Dettinger, Julia, Calkins, Kimberly, Kibore, Minnie, Gachuno, Onesmus, Walker, Dilys
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825011/
https://www.ncbi.nlm.nih.gov/pubmed/29474397
http://dx.doi.org/10.1371/journal.pone.0184252
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author Cranmer, John N.
Dettinger, Julia
Calkins, Kimberly
Kibore, Minnie
Gachuno, Onesmus
Walker, Dilys
author_facet Cranmer, John N.
Dettinger, Julia
Calkins, Kimberly
Kibore, Minnie
Gachuno, Onesmus
Walker, Dilys
author_sort Cranmer, John N.
collection PubMed
description BACKGROUND: Globally, the rate of reduction in delivery-associated maternal and perinatal mortality has been slow compared to improvements in post-delivery mortality in children under five. Improving clinical readiness for basic obstetric emergencies is crucial for reducing facility-based maternal deaths. Emergency readiness is commonly assessed using tracers derived from the maternal signal functions model. OBJECTIVE-METHOD: We compare emergency readiness using the signal functions model and a novel clinical cascade. The cascades model readiness as the proportion of facilities with resources to identify the emergency (stage 1), treat it (stage 2) and monitor-modify therapy (stage 3). Data were collected from 44 Kenyan clinics as part of an implementation trial. FINDINGS: Although most facilities (77.0%) stock maternal signal function tracer drugs, far fewer have resources to practically identify and treat emergencies. In hypertensive emergencies for example, 38.6% of facilities have resources to identify the emergency (Stage 1 readiness, including sphygmomanometer, stethoscope, urine collection device, protein test). 6.8% have the resources to treat the emergency (Stage 2, consumables (IV Kit, fluids), durable goods (IV pole) and drugs (magnesium sulfate and hydralazine). No facilities could monitor or modify therapy (Stage 3). Across five maternal emergencies, the signal functions overestimate readiness by 54.5%. A consistent, step-wise pattern of readiness loss across signal functions and care stage emerged and was profoundly consistent at 33.0%. SIGNIFICANCE: Comparing estimates from the maternal signal functions and cascades illustrates four themes. First, signal functions overestimate practical readiness by 55%. Second, the cascade’s intuitive indicators can support cross-sector health system or program planners to more precisely measure and improve emergency care. Third, adding few variables to existing readiness inventories permits step-wise modeling of readiness loss and can inform more precise interventions. Fourth, the novel aggregate readiness loss indicator provides an innovative and intuitive approach for modeling health system emergency readiness. Additional testing in diverse contexts is warranted.
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spelling pubmed-58250112018-03-19 Beyond signal functions in global obstetric care: Using a clinical cascade to measure emergency obstetric readiness Cranmer, John N. Dettinger, Julia Calkins, Kimberly Kibore, Minnie Gachuno, Onesmus Walker, Dilys PLoS One Research Article BACKGROUND: Globally, the rate of reduction in delivery-associated maternal and perinatal mortality has been slow compared to improvements in post-delivery mortality in children under five. Improving clinical readiness for basic obstetric emergencies is crucial for reducing facility-based maternal deaths. Emergency readiness is commonly assessed using tracers derived from the maternal signal functions model. OBJECTIVE-METHOD: We compare emergency readiness using the signal functions model and a novel clinical cascade. The cascades model readiness as the proportion of facilities with resources to identify the emergency (stage 1), treat it (stage 2) and monitor-modify therapy (stage 3). Data were collected from 44 Kenyan clinics as part of an implementation trial. FINDINGS: Although most facilities (77.0%) stock maternal signal function tracer drugs, far fewer have resources to practically identify and treat emergencies. In hypertensive emergencies for example, 38.6% of facilities have resources to identify the emergency (Stage 1 readiness, including sphygmomanometer, stethoscope, urine collection device, protein test). 6.8% have the resources to treat the emergency (Stage 2, consumables (IV Kit, fluids), durable goods (IV pole) and drugs (magnesium sulfate and hydralazine). No facilities could monitor or modify therapy (Stage 3). Across five maternal emergencies, the signal functions overestimate readiness by 54.5%. A consistent, step-wise pattern of readiness loss across signal functions and care stage emerged and was profoundly consistent at 33.0%. SIGNIFICANCE: Comparing estimates from the maternal signal functions and cascades illustrates four themes. First, signal functions overestimate practical readiness by 55%. Second, the cascade’s intuitive indicators can support cross-sector health system or program planners to more precisely measure and improve emergency care. Third, adding few variables to existing readiness inventories permits step-wise modeling of readiness loss and can inform more precise interventions. Fourth, the novel aggregate readiness loss indicator provides an innovative and intuitive approach for modeling health system emergency readiness. Additional testing in diverse contexts is warranted. Public Library of Science 2018-02-23 /pmc/articles/PMC5825011/ /pubmed/29474397 http://dx.doi.org/10.1371/journal.pone.0184252 Text en © 2018 Cranmer et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Cranmer, John N.
Dettinger, Julia
Calkins, Kimberly
Kibore, Minnie
Gachuno, Onesmus
Walker, Dilys
Beyond signal functions in global obstetric care: Using a clinical cascade to measure emergency obstetric readiness
title Beyond signal functions in global obstetric care: Using a clinical cascade to measure emergency obstetric readiness
title_full Beyond signal functions in global obstetric care: Using a clinical cascade to measure emergency obstetric readiness
title_fullStr Beyond signal functions in global obstetric care: Using a clinical cascade to measure emergency obstetric readiness
title_full_unstemmed Beyond signal functions in global obstetric care: Using a clinical cascade to measure emergency obstetric readiness
title_short Beyond signal functions in global obstetric care: Using a clinical cascade to measure emergency obstetric readiness
title_sort beyond signal functions in global obstetric care: using a clinical cascade to measure emergency obstetric readiness
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825011/
https://www.ncbi.nlm.nih.gov/pubmed/29474397
http://dx.doi.org/10.1371/journal.pone.0184252
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