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Instituto Nacional de Salud Pública

2021, Number 2

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salud publica mex 2021; 63 (2)

Deficiencies and variability in the quality of care for hospitalized neonates in Mexico

Saturno-Hernández PJ, Poblano-Verástegui O, Flores-Hernández S, Martínez-Nicolás I, Vieyra-Romero W, Halley-Castillo ME

Language: Spanish
References: 33
Page: 180-189
PDF size: 271.54 Kb.


ABSTRACT

Objective. To evaluate the quality of care to newborns with process indicators, in selected pathologies. Materials and methods. Multi-centric, cross-sectional evaluation of 9 indicators in 28 hospitals in 11 States of Mexico. Lot Quality Assurance Sampling (LQAS) was used for quality standards and sample per hospital. Randomly selected cases from the Automated Hospital Discharge Subsystem. The hospitals are classified as “standard compliance”/”non-compliance” by indicator and, compliance with 95%CI exact binomial, regional and national, according to non-proportional stratified sampling. Results. No indicator meets the standard of 75% in hospitals, with range from 0 to 19 hospitals that meet, according to indicator. Except for timely identification of perinatal asphyxia and onset of correct antibiotics in suspected early sepsis, the compliance is ‹50% on all other indicators. Conclusions. The quality of care for newborns in hospitals is heterogeneous and poor. Indicators are proposed to monitor improvement initiatives.


REFERENCES

  1. United Nations Children´s Fund. Levels and trends in child mortality: Report 2019. Estimates developed by the UN Interagency group for child mortality estimation. Nueva York: UNICEF, 2019 [citado mayo 12, 2020]. Disponible en: https://www.unicef.org/ media/60561/file/UN-IGME-child-mortality-report-2019.pdf

  2. World Health Organization. World health statistics data visualizations dashboard: Neonatal mortality. Ginebra: WHO, 2019 [citado mayo 12, 2020]. Disponible en: https://apps.who.int/gho/data/node.sdg.3-2-viz-3?lang=en

  3. Chawanpaiboon S, Vogel JP, Moller AB, Lumbiganon P, Petzold M, Hogan D, et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling análisis. Lancet Glob Health. 2019;7(1):e37-46. https://doi.org/10.1016/S2214-109X(18)30451-0

  4. González-Pier E, Barraza-Lloréns M, Beyeler N, Jamison D, Knaul F, Lozano R, et al. Mexico’s path towards the Sustainable Development Goal for health: an assessment of the feasibility of reducing premature mortality by 40% by 2030. Lancet Glob Heal. 2016;4(10):e714-25. https://doi. org/10.1016/S2214-109X(16)30181-4

  5. Celhay P, Martinez S, Muñoz M, Perez M, Perez-Cuevas R. Long-term effects of public health insurance on the health of children in Mexico: a retrospective study. Lancet Glob Health. 2019;7(10):e1448-57. https://doi. org/10.1016/S2214-109X(19)30326-2

  6. García-Díaz R, Sosa-Rubí SG, Serván-Mori E, Nigenda G. Welfare effects of health insurance in Mexico: The case of Seguro Popular de Salud. PLoS One. 2018;13(7):e0199876. https://doi.org/10.1371/journal.pone.0199876

  7. World Health Organization, Organization for Economic Co-operation and Development, International Bank for Reconstruction and Development. Delivering quality health services: a global imperative for universal health coverage. Ginebra: WHO/OCD/Wold Bank, 2018 [citado agosto 31, 2020]. Disponible en: https://apps.who.int/iris/handle/10665/272465

  8. World Health Organization. Newborns: improving survival and wellbeing. Ginebra: WHO, 2020 [citado mayo 12, 2020]. Disponible en: https:// www.who.int/news-room/fact-sheets/detail/newborns-reducing-mortality

  9. 9.GBD 2015 Maternal Mortality Collaborators. Global, regional, and national levels of maternal mortality, 1990-2015: a systematic analysis for the global burden of disease study 2015. Lancet. 2016;388(10053):1775-812. https://doi.org/10.1016/S0140-6736(16)31470-2

  10. Aguilera N, Marrufo GM. Can better infrastructure and quality reduce hospital infant mortality rates in Mexico? Health Policy. 2007;80(2):239-52. https://doi.org/10.1016/j.healthpol.2006.03.003

  11. 11.Pérez-Cuevas R, Muñoz-Hernández O, Rodríguez-Ortega E, Jasso- Gutiérrez L, Flores-Huerta S, Durán-Arenas L, et al. Design of the 2009 evaluation of the Medical Insurance for a New Generation program. Salud Publica Mex. 2012;54(supl 1):S11-9. https://doi.org/10.1590/s0036- 36342012000700003

  12. Durán-Arenas L, Aldaz-Rodríguez V, Jasso-Gutiérrez L, Flores-Huerta S, Hernández-Ramírez L del C, Zurita JM. Quality of health care of the medical units that provide services for Medical Insurance for a New Generation enrollees. Salud Publica Mex. 2012;54(supl 1):S42-9. https:// doi.org/10.1590/s0036-36342012000700006

  13. Pérez-Cuevas R, Doubova SV, Jasso-Gutiérrez L, Flores-Hernández S, O´Shea-Cuevas G, Aranza-Doniz C, et al. Evaluation of the quality of care of neonates with necrotizing enterocolitis affiliated with Seguro Popular in Mexico. Bol Med Hosp Infant Mex. 2014;71(2):76-82 [citado agosto 30, 2020]. Disponible en: http://www.scielo.org.mx/pdf/bmim/v71n2/v71n2a3.pdf

  14. Pérez-Cuevas R, Jasso-Gutiérrez L, Doubova S, Flores-Hernández S, Mantilla-Trollé C, González-Guerra E, et al. Evaluation of the quality of care of transient tachypnea in newborns affiliated with the Medical Insurance Siglo XXI program. Bol Med Hosp Infant Mex. 2014;71(6):346-51. https://doi.org/10.1016/j.bmhimx.2015.01.007

  15. Doubova SV, Josefa-García H, Coronado-Zarco IA, Carrera-Muiños S, Cordero-González G, Cruz-Reynoso L, et al. Evaluating the quality of the processes of care and clinical outcomes of premature newborns admitted to neonatal intensive care units in Mexico. Int J Qual Health Care. 2018;30(8):608-17. https://doi.org/10.1093/intqhc/mzy061

  16. Saturno-Hernández PJ, Poblano-Verástegui O, Flores-Hernández S, Ángel-García D, O’Shea-Cuevas GJ, Villagrán-Muñoz VM, et al. Indicadores de calidad de la atención a neonatos con patologías seleccionadas: estudio piloto. Salud Publica Mex. 2019;61(1):35-45. https://doi.org/10.21149/9271

  17. Sankar MJ, Natarajan CK, Das RR, Agarwal R, Chandrasekaran A, Paul VK. When do newborns die? A systematic review of timing of overall and cause-specific neonatal deaths in developing countries. J Perinatol. 2016;36(supl 1):S1-11. https://doi.org/10.1038/jp.2016.27

  18. World Health Organization. Health statistics and information systems: WHO mortality database. Ginebra: WHO, 2016 [citado mayo 12, 2020]. Disponible en: http://www.who.int/healthinfo/mortality_data/en/

  19. Walker D, Otieno P, Butrick E, Namazzi G, Achola K, Merai R, et al. Effect of a quality improvement package for intrapartum and immediate newborn care on fresh stillbirth and neonatal mortality among preterm and low-birthweight babies in Kenya and Uganda: a cluster-randomised facility-based trial. Lancet Glob Health. 2020;8(8):e1061-70. https://doi. org/10.1016/S2214-109X(20)30232-1

  20. Saturno-Hernández PJ, Martínez-Nicolás I, Moreno-Zegbe E, Fernández- Elorriaga M, Poblano-Verástegui O. Indicators for monitoring maternal and neonatal quality care: a systematic review. BMC Pregnancy Childbirth. 2019;25. https://doi.org/10.1186/s12884-019-2173-2

  21. Peterson ED, Delong ER, Masoudi FA, O´Brien SM, Peterson PN, Rumsfeld JS, et al. ACCF/AHA 2010 Position statement on composite measures for healthcare performance assessment: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures. Circulation. 2010;121(15):1780-91. https://doi. org/10.1161/CIR.0b013e3181d2ab98

  22. Saturno PJ. La distribución binomial y el muestreo para la aceptación de lotes (LQAS) como métodos de monitorización en servicios de salud. Rev Calid Asist. 2000;15(2):99-107 [citado agosto 30, 2020]. Disponible en: https://www.researchgate.net/publication/284286561

  23. 23.Rath RS, Solanki HK. Review of lot quality assurance sampling, methodology and its application in public health. Nepal J Epidemiol. 2019;9(3):781-7. https://doi.org/10.3126/nje.v9i3.24507

  24. 24.Lemeshow S, Hosmer DW, Klar J, Lwanga SK, World Health Organization. Adequacy of sample size in health studies. Chichester: John Whiley & Sons Ltd,1990 [citado agosto 30, 2020]. Disponible en: https://apps.who. int/iris/handle/10665/41607

  25. Saturno-Hernández PJ. Métodos y herramientas para la monitorización de la calidad en servicios de salud. Cuernavaca: Instituto Nacional de Salud Pública, 2015 [citado septiembre 5, 2020]. Disponible en: https:// www.insp.mx/resources/images/stories/Produccion/pdf/160509_Manual_ Monitorizacion_6 Nov.pdf

  26. Clopper CJ, Pearson ES. The use of confidence or fiducial limits illustrated in the case of the binomial. Biometrika. 1934;26(4):404-13. https:// doi.org/10.2307/2331986

  27. Hofstetter AM, Jacobson EN, de Hart MP, Englund JA. Early childhood vaccination status of preterm infants. Pediatrics. 2019;144(3):e20183520. https://doi.org/10.1542/peds.2018-3520

  28. Parikh P, Juul SE. Neuroprotective strategies in neonatal brain injury. J Pediatr. 2018;192:22-32. https://doi.org/10.1016/j.jpeds.2017.08.031

  29. Chiappini E, Petronili C, Sandini E, Licari A, Pugni L, Mosca FA, et al. Update on vaccination of preterm infants: a systematic review about safety and efficacy/effectiveness. Proposal for a position statement by Italian Society of Pediatric Allergology and Immunology jointly with the Italian Society of Neonatology. Expert Rev Vaccines. 2019;18(5):523-45. https:// doi.org/10.1080/14760584.2019.1604230

  30. Robinson TP, Bub DP, Carrique-Masc J, Fèvred EM, Gilberte M, Grace D, et al. Antibiotic resistance is the quintessential One Health issue. Trans R Soc Trop Med Hyg. 2016;110(7):377-80. https://doi.org/10.1093/trstmh/ trw048

  31. Cotten CM. Antibiotic stewardship: reassessment of guidelines for management of neonatal sepsis. Clin Perinatol. 2015;42(1):195-206. https:// doi.org/10.1016/j.clp.2014.10.007

  32. Weiss KJ, Kowalkowski MA, Treviño R, Cabrera-Meza G, Thomas EJ, Kaplan HC, et al. Needs assessment to improve neonatal intensive care in Mexico. Paediatr Int Child Health. 2015;35(3):213-9. https://doi.org/10.117 9/2046905515Y.0000000044

  33. Chou VB, Walker N, Kanyangarara M. Estimating the global impact of poor quality of care on maternal and neonatal outcomes in 81 low- and middle-income countries: A modeling study. PLoS Med. 2019;16(12):e1002990. https://doi.org/10.1371/journal.pmed.1002990




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