Study On The Effectiveness Evaluation Of Iud-Sopthrough Application Oftotal Quality Management In Familyplan Clinics

BackgroundIUD (Intrauterine Device, IUD) is a long-running, reversible, simple contraceptive method.In the family planning Intrauterine Device (IUD) plays a very important role. However, currently the failure rate of China’s rural women IUD placement is high. There are some deficiencies in the operability on China’s family planning technical standard The quality of IUD placement needs to be greatly improved.The standard operating procedures of IUDs and contraceptive implant about placement, removement and prevention of surgical complications> has been taken for operating more standardized. However, service agencies of different areas and levels implement new practices vary considerably. Researches confirmed that it is crucial that the strict implementation of conventional technology ensures the routine services safe.In the late 1980s, some developed countries have adopted "Total Quality Management" (TQM) to improve quality of care and to conduct health care reform. Studies have shown that "Total Quality Management" may make the implementation of the technical routine more effective and is the cornerstone to improve service quality. But there are few studies about TQM in family plan especially on the placement of IUD. In this study, TQM as interventions, the implementation of IUD-SOP and the effect after the intervention are evaluated by scenario analysis in primary family planning agencies.ObjectivesThe TQM on IUD-SOP was implemented as intervention at primary family planning institutions of Yunnan and Anhui provinces. After the intervention the effect was evaluated. The study would provide scientific basis for further exploring the standardized implementation of IUD-SOP and improving the quality of placement of IUD. The conclusion may make recommendations for the health policy development and reform of the government.MethodsThis study relies on the National Natural Science Foundation<the Multidimensional Assessment of TQM and the study on clinical path about IUD placement technical services in rural women of childbearing age> (71103002). The TQM pattern of IUD placement technical services (IUD-TQM) was implemented experimentally at primary family planning institutions in Yunnan Province and Anhui Province. The methods included:The implementation of IUD insertion standard operating procedure (IUD-SOP) was preliminarily evaluated by scenario analysis in primary family planning agencies. The method of investigation and evaluation in this study is mainly through "The Test of Training and Theoretical Knowledge(QJ-12)"," The IUD Hardware Service Observation List (QJ-3) "and" IUD Inserted Skill Observation List (QJ-4) (see Appendix).Through the baseline survey, the difference and the problems between in family planning clinics at country and township was analyzed. Then the TQM of IUD-SOP was implemented as intervention. Scenario analysis method was applied again to further evaluate the effect after the intervention.Main Results1. The Results of Baseline:1) Basic information of staff providing IUD insertion service in family planning clinics at country and township:There were 496 pepole received,168 from township and 328 from county. There was significant difference in age, educational levels, professional titles and Practitioners type between county and township (p<0.01)2) Theoretical score:Except basic knowledge there was significant difference in other three items between county and township (p< 0.05). The scores of county family planning clinics were higher than township.3) The operation of quality management and Hardware assessment:Except management of sterile device there was significant difference in other five items between county and township (p< 0.05). The scores of county were higher than township.4) The procedure of IUD insertion service:Except Patient medical records and preoperative consent there was significant difference in other six items between county and township (p< 0.05). The scores of county were higher than township. 2.The Results after intervention:1) Whether the county and township there were significant higher in the basic, disinfectant, clinical and conventional knowledge scores after intervention (p< 0.01 in county; p< 0.05 in township).2) The operation of quality management and hardware assessment:There was higher score in every item after intervention in two county clinics as the intervention group.Except management of sterile device and completeness of emergency medicine there was no significant difference in other four items after intervention in six township clinics as the intervention group although the score was higher in every item (p< 0.05).3) The procedure of IUD insertion service:There was higher score in every item after intervention in two county clinics as the intervention group.Except Patient medical records, Preoperative consent and the score of disinfection technique to observe, there was significant better in other four items after intervention in six township clinics as the intervention group (p< 0.05).Conclusions and suggestions1. In the baseline survey the implementation of the IUD-SOP is not ideal in the pilot areas. The quality of IUD placement would be greatly improved.2. Through application of total quality management IUD-SOP was implemented more effectively. The quality of IUD placement was improved.3. The necessity and feasibility of applying TQM were demonstrated from effective implementation IUD-SOP at primary family planning staff.