Effect of a multifaceted intervention with audit and feedback on low-risk childbirth practice: a multicentre prospective study
Abstract Background Care for low-risk childbirths constitutes a large proportion of deliveries and is highly influenced by factors such as region, birthing facilities, and health care providers. Audit and feedback as a quality indicator (QI) intervention alone have limited effectiveness. Multidiscip...
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| Language: | English |
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BMC
2025-05-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | https://doi.org/10.1186/s12884-025-07681-2 |
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| author | Kayo Ueda Mai Takeshita Yoshimitsu Takahashi Hatoko Sasaki Naoki Ozu Takeo Nakayama |
| author_facet | Kayo Ueda Mai Takeshita Yoshimitsu Takahashi Hatoko Sasaki Naoki Ozu Takeo Nakayama |
| author_sort | Kayo Ueda |
| collection | DOAJ |
| description | Abstract Background Care for low-risk childbirths constitutes a large proportion of deliveries and is highly influenced by factors such as region, birthing facilities, and health care providers. Audit and feedback as a quality indicator (QI) intervention alone have limited effectiveness. Multidisciplinary approaches, including QI and organizational development, are reportedly effective; however, the impact on low-risk childbirth care remains unclear. We aimed to assess the impact of multifaceted intervention, including audit and feedback, on improving care for low-risk childbirths using QIs. Methods We conducted a 1-year pre–post comparison targeting healthy pregnant women in four obstetric wards in Japan. The intervention included audit and feedback combined with multifaceted approaches, improvement efforts by a multidisciplinary team, and educational training on health care quality and organizational culture. The outcomes were 12 QIs. The main analysis used interrupted time-series analysis over 6 months pre- and post-intervention. We compared the 9 months pre-intervention with 3 months post-intervention in secondary analysis to assess delayed effects. Results We included 288 women pre-intervention and 167 women post-intervention. “The spontaneous vaginal delivery indicator showed a significant increase in slope (risk ratio [RR] 1∙08, 95% confidence interval [CI]: 1∙00–1∙16, p < 0∙05), indicating a trend-based improvement rather than an immediate change per month in the main analysis. Secondary analysis showed a significant increase in the administration of uterotonic agents during the third stage of labour (RR 1∙19, 95% CI: 1∙01–1∙41, p < 0∙05). Conclusion The improvement effects of multifaceted interventions, including audit and feedback, using QIs for low-risk childbirths were limited. However, some indicators may improve over time, suggesting a potential delayed effect. Trial registration Not applicable. |
| format | Article |
| id | doaj-art-98ee6d5768ba4b39a5a0f21e8628fa9a |
| institution | DOAJ |
| issn | 1471-2393 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj-art-98ee6d5768ba4b39a5a0f21e8628fa9a2025-08-20T03:10:31ZengBMCBMC Pregnancy and Childbirth1471-23932025-05-0125111310.1186/s12884-025-07681-2Effect of a multifaceted intervention with audit and feedback on low-risk childbirth practice: a multicentre prospective studyKayo Ueda0Mai Takeshita1Yoshimitsu Takahashi2Hatoko Sasaki3Naoki Ozu4Takeo Nakayama5Department of Nursing Women’s Health & Midwifery, Faculty of Nursing, Nara Medical University School of MedicineDepartment of Health Informatics, Kyoto University School of Public HealthDepartment of Health Informatics, Kyoto University School of Public HealthShizuoka Graduate University of Public HealthInstitute for Clinical and Translational Science, Nara Medical University HospitalDepartment of Health Informatics, Kyoto University School of Public HealthAbstract Background Care for low-risk childbirths constitutes a large proportion of deliveries and is highly influenced by factors such as region, birthing facilities, and health care providers. Audit and feedback as a quality indicator (QI) intervention alone have limited effectiveness. Multidisciplinary approaches, including QI and organizational development, are reportedly effective; however, the impact on low-risk childbirth care remains unclear. We aimed to assess the impact of multifaceted intervention, including audit and feedback, on improving care for low-risk childbirths using QIs. Methods We conducted a 1-year pre–post comparison targeting healthy pregnant women in four obstetric wards in Japan. The intervention included audit and feedback combined with multifaceted approaches, improvement efforts by a multidisciplinary team, and educational training on health care quality and organizational culture. The outcomes were 12 QIs. The main analysis used interrupted time-series analysis over 6 months pre- and post-intervention. We compared the 9 months pre-intervention with 3 months post-intervention in secondary analysis to assess delayed effects. Results We included 288 women pre-intervention and 167 women post-intervention. “The spontaneous vaginal delivery indicator showed a significant increase in slope (risk ratio [RR] 1∙08, 95% confidence interval [CI]: 1∙00–1∙16, p < 0∙05), indicating a trend-based improvement rather than an immediate change per month in the main analysis. Secondary analysis showed a significant increase in the administration of uterotonic agents during the third stage of labour (RR 1∙19, 95% CI: 1∙01–1∙41, p < 0∙05). Conclusion The improvement effects of multifaceted interventions, including audit and feedback, using QIs for low-risk childbirths were limited. However, some indicators may improve over time, suggesting a potential delayed effect. Trial registration Not applicable.https://doi.org/10.1186/s12884-025-07681-2Audit and feedbackQuality improvementQuality of health careQuality indicatorsObstetric deliveryMidwifery |
| spellingShingle | Kayo Ueda Mai Takeshita Yoshimitsu Takahashi Hatoko Sasaki Naoki Ozu Takeo Nakayama Effect of a multifaceted intervention with audit and feedback on low-risk childbirth practice: a multicentre prospective study BMC Pregnancy and Childbirth Audit and feedback Quality improvement Quality of health care Quality indicators Obstetric delivery Midwifery |
| title | Effect of a multifaceted intervention with audit and feedback on low-risk childbirth practice: a multicentre prospective study |
| title_full | Effect of a multifaceted intervention with audit and feedback on low-risk childbirth practice: a multicentre prospective study |
| title_fullStr | Effect of a multifaceted intervention with audit and feedback on low-risk childbirth practice: a multicentre prospective study |
| title_full_unstemmed | Effect of a multifaceted intervention with audit and feedback on low-risk childbirth practice: a multicentre prospective study |
| title_short | Effect of a multifaceted intervention with audit and feedback on low-risk childbirth practice: a multicentre prospective study |
| title_sort | effect of a multifaceted intervention with audit and feedback on low risk childbirth practice a multicentre prospective study |
| topic | Audit and feedback Quality improvement Quality of health care Quality indicators Obstetric delivery Midwifery |
| url | https://doi.org/10.1186/s12884-025-07681-2 |
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