Skip to main content

Advertisement

SpringerLink
Log in

Catalytic Support for Improving Clinical Care in Special Newborn Care Units (SNCU) Through Composite SNCU Quality of Care Index (SQCI)

  • Research Paper
  • Published:
Indian Pediatrics Aims and scope Submit manuscript

Abstract

Objective

To develop a composite index that serves as a proxy marker of quality of clinical service and pilot test its use in 11 special neonatal care units (SNCUs) across two states in India.

Design

Secondary data from SNCU webportal.

Settings

Special new-born care units in Rajasthan and Orissa.

Intervention

We developed a composite SNCU Quality of care Index (SQCI) based on seven indices from SNCU online database. These included rational admission index, index for rational use of antibiotics, inborn birth asphyxia index, index for mortality in normal weight babies, low birth weight admission index, low birth weight survival index, and optimal bed utilization index.

Outcome

Based on the SQCI score, the performance of SNCUs was labelled as good (SQCI 0.71–1.0), satisfactory (SQCI 0.4–0.7) or unsatisfactory (SQCI <0.4).

Results

The mean difference in SQCI between Jan-Mar 2016 and 2017 was 0.20 (95% CI 0.13–0.28; P<0.001). Similar results were obtained for rational admission index, rational use of antibiotics, mortality in normal weight babies, low birth weight survival and optimal bed utilization. A significant improvement in the overall composite score was noted in Odisha (Mean difference 0.22, 95% CI 0.11–0.33, P=0.003) and Rajasthan (Mean difference 0.17, 95% CI 0.05–0.3, P=0.002).

Conclusion

QI approach using SQCI tool is a useful and replicable intervention. Preliminary results show that it does lead to strengthening of implementation of the programs at SNCUs based on the comprehensive scores generated as part of routine system.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Facility based newborn care: Operational guidelines. In: Ministry of Health and Family Welfare, editor. New Delhi: Ministry of Health and Family Welfare, Government of India; 2011.

  2. Ministry of Health and Family Welfare. Health Management Information System. In: Ministry of Health and Family Welfare, editor. Ministry of Health and Family Welfare, Govt of India; 2017.

  3. MOHFW. Special Newborn Care Units in India. In: Ministry of Health and Family Welfare, editor. New Delhi 2017.

  4. Strengthening Facility Based Paediatric Care: Operational Guidelines for Planning & Implementation in District Hospitals. In Child Health Division, Ministry of Health and Family Welfare, Government of India, New Delhi. September 2015. Accessed on November 16, 2020. Available from: https://nhm.gov.in/images/pdf/programmes/child-health/guidelines/Strenghtening_FacilityBasedPaediatricCare-OperationalGuidelines.pdf

  5. Neogi SB, Malhotra S, Zodpey S, Mohan P. Assessment of special care newborn units in India. Health Pop Nutr. 2011;29:500–9.

    Google Scholar 

  6. Neogi SB, Malhotra S, Zodpey S, Mohan P. Challenges in scaling up of special care newborn units-Lessons from India. Indian Pediatr. 2011;48:931–5.

    Article  Google Scholar 

  7. Sharma G, Powell-Jackson T, Haldar K, Bradley J, Filippi V. Quality of routine essential care during childbirth: Clinical observations of uncomplicated births in Uttar Pradesh, India. Bull World Health Organ. 2017;95:419–29.

    Article  Google Scholar 

  8. Iyengar K, Jain M, Thomas S, et al. Adherence to evidence based care practices for childbirth before and after a quality improvement intervention in health facilities of Rajasthan, India. BMC Pregn Childbirth. 2014;14:270.

    Article  Google Scholar 

  9. Chauhan M, Sharma J, Negandhi P, Reddy S, Sethy G, Neogi S. Assessment of newborn care corners in selected public health facilities in Bihar. Indian J Public Health. 2016;60:341–6.

    Article  Google Scholar 

  10. Chawla D, Suresh GK. Quality improvement in neonatal care — A new paradigm for developing countries. Indian J Pediatr. 2014;81:1367–72.

    Article  Google Scholar 

  11. Neogi SB, Malhotra S, Zodpey S, Mohan P. Does facility-based newborn care improve neonatal outcomes?. A review of evidence. Indian Pediatrics. 2012;49:651–58.

    Article  Google Scholar 

  12. Sarin E, Kole SK, Patel R, et al. Evaluation of a quality improvement intervention for obstetric and neonatal care in selected public health facilities across six states of India. BMC Pregn Childbirth. 2017;17:134.

    Article  Google Scholar 

  13. Neogi SB, Shetty G, Ray S, Sadhukhan P, Reddy SS. Setting up a quality assurance model for newborn care to strengthen health system in Bihar, India. Indian Pediatr. 2014;51:136–8.

    Article  Google Scholar 

  14. Vagias WM. Likert -type scale response anchors. Clemson University: Department of Parks, Recreation and Tourism Management, 2006.

  15. Nadeem E, Olin SS, Hill LC, Hoagwood KE, Horwitz SM. Understanding the components of quality improvement collaboratives: a systematic literature review. Milbank Q. 2013;91:354–94.

    Article  Google Scholar 

  16. Mehndiratta A. Quality Improvement of Facility Based New Born Care in India: ACCESS health International; 2014; Available from: http://accessh.org/wp-content/uploads/2014/07/Quality-Improvement-of-Facility-Based-Newborn-Care-in-India-Poster.pdf

  17. Sharma J, Neogi S, Negandhi P, Chauhan M, Reddy S, Sethy G. Rollout of quality assurance interventions in labor room in two districts of Bihar, India. Indian J Public Hlth. 2016;60:323–8.

    Article  Google Scholar 

  18. Horbar JD. The Vermont Oxford Network: Evidence-based quality improvement for neonatology. Pediatrics. 1999;103:350–9.

    CAS  PubMed  Google Scholar 

  19. Horbar JD, Rogowski J, Plsek PE, et al. Collaborative quality improvement for neonatal intensive care. NIC/Q Project Investigators of the Vermont Oxford Network. Pediatrics. 2001;107:14–22.

    Article  CAS  Google Scholar 

  20. Hernández-Borges AA, Pérez-Estévez E, Jiménez-Sosa A, et al. Set of quality indicators of pediatric intensive care in Spain: Delphi method selection. Pediatr Qual Safety. 2017;2:e009.

    Article  Google Scholar 

  21. Profit J, Zupancic JA, Gould JB, et al. Correlation of neonatal intensive care unit performance across multiple measures of quality of care. JAMA Pediatr. 2013;167:47–54.

    Article  Google Scholar 

  22. Lachman P, Jayadev A, Rahi M. The case for quality improvement in the neonatal intensive care unit. Early Human Dev. 2014;90:719–23.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. VRIDDHI, IPE Global Ltd., New Delhi, India

    Harish Kumar & Prasant Kumar Saboth

  2. Norway India Partnership Initiative, New Delhi, India

    Rajat Khanna, Ashfaq Ahmed Bhat & Pradeep Choudhry

  3. Department of Pediatrics, Kalawati Saran Children’s Hospital, New Delhi, India

    Varun Alwadhi

  4. International Institute of Health Management Research, New Delhi, India

    Sutapa B. Neogi

  5. Ministry of Health and Family Welfare, Government of India, New Delhi, India

    Ajay Khera

Authors
  1. Harish Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rajat Khanna
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Varun Alwadhi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ashfaq Ahmed Bhat
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sutapa B. Neogi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pradeep Choudhry
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Prasant Kumar Saboth
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ajay Khera
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ashfaq Ahmed Bhat.

Additional information

Contributors

HK: conceptualized SQCI and provided technical oversight of the process of SQCI analysis and use; RK: developed the statistical model during conceptualization of SQCI, analyzed data, interpreted the results and contributed to writing of the manuscript. VA,AK: provided technical support during conceptualization of SQCI, monitoring indicators and reviewed the manuscript; AAB: contributed in the framing of monitoring indicators and reviewed the manuscript SBN: reviewed the literature and drafted the manuscript; PC,PKS: implemented SQCI in their respective states, reviewed manuscript and provided inputs.

Funding

This study was conducted as part of the Newborn care project supported by Norway India Partnership Initiative (NIPI)

Competing interest

None stated.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kumar, H., Khanna, R., Alwadhi, V. et al. Catalytic Support for Improving Clinical Care in Special Newborn Care Units (SNCU) Through Composite SNCU Quality of Care Index (SQCI). Indian Pediatr 58, 338–344 (2021). https://doi.org/10.1007/s13312-021-2192-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13312-021-2192-8

Keywords

Search

Navigation