Establishment Of Evaluation Indicator System For Postpartum Care Institution

BACKGROUDPostpartum is an important period for maternal body organs to recover after delivery and the critical period for newborn growth. Improper care will make Maternal and Child prone to complications. According to the WHO report, the mortality during puerperium in developing countries is more than the sum of that during pregnancy and childbirth, the overall incidence of diseasesduring puerperium is comparable to that of the disease during pregnancy. Therefore, intensive care during this period will play a very important role on maternal and child health.Postpartum care,commonly known as "doing the month", refers to the care lasting for one month from the delivery, which is unique to China’s post-natal care culture. Postpartum care institution, a new industry from the old folk, is a business model combining folk heritage and the introduction of modern medicine and modern business body. Postpartum care institution, as a new format of service, which clients are women and infant discharged from hospital after delivery. It provides comprehensive, professional and integrated services mainly from the postnatal infant feeding, health care and maternal physical and psychological recovery. Studies have shown that postpartum care institutions can offer practical support to help reduce postpartum stress and improve overall health. Due to the change of life concept and social needs, postpartum care institution have sprung up one after another. According to incomplete statistics, currently there are 2000-3000 postpartum care institutions. With the two-child policy and 80s generation in the reproductive age, postpartum care institutionson behalf of maternal and child care service will undoubtedly have a vast potential market, the social effects of maternal and child health-care market is also very obvious. Premier Li Keqiang mentioned in the "Government Work Report":the emerging industry and new type of business are competitive. Therefore, it isnecessary to attach importance to construct maternal and child care institutions from a strategic angle,, supporting the implementation of second-child policy.Currently, Markets of postpartum care institutions in Taiwan have been quite mature. Taiwan Evaluation Association commissioned by the Ministry of Health and Welfare conducts field evaluation activities towards postpartum care institutions every year, and the evaluation criteria and the evaluation results were published online. In mainland, postpartum care institutions belongs to emerging industry, the state has not yet introduced the industry standard. The lack of admission and practice criterion, immature market and unclear industry regulator are no doubt increasing the risk for the future development of the market, which not only do not help postpartum recovery, but poses a serious harm to the maternal and child health, forming a sharp challenge to the service quality and operational security of the industry. It is an urgent need to establish uniform service standards and evaluation index system.OBJECTIVEThis study aims to establish the evaluation indicator system for postpartum care institution which is scientific and normative by Delphi method and Analytic Hierarchy Process (AHP) based on fully literature consulting, investigation aboutservices as well as maternal needs and attitude of postpartum care institution.In addition, tentativeexplorationon empirical study was performed in order to provide scientific and effective tool to measure postpartum care institutions, as a reference for the regulation of postpartum care market, and ultimately improving the health of mothers and babies.STUDY SUBJECTS AND METHODS1. Needs and status investigation. Based on full literature review, a total of 285 pregnant women from four hospitals in Guangdong Province were investigated face to face by self-designed questionnaire "demand survey on maternal service demands towards Institute of Postpartum Care", containing the general data, attitudes towards postpartum care institutions and service needs. And a total of 27 postpartum care institution from different tier cities of Guangdong were investigated by self-designed questionnaire "survey on configuration and service of postpartum care institution". The questionnaire consists of staffing, infrastructure and service content of postpartum care institution.2. Experts consulting and system construction. According to the basic principles of constructing evaluation index system, referring to the Taiwanese evaluation standard of postpartum care institutions, combining the findings in the previous step, developing the expert consultation questionnaire on evaluation index system of postpartum care institutions. In this study, after two-round expert consulting,22 experts’opinions and results were collated and statisticalanalyzedto initially established evaluation index system of postpartum care institutions, combining with feedback and admission screening criteria3.Hierarchical analysis, weights settings.According to the means of importance assignment of indicators in two rounds of expert consultation to determine the Saaty scale, judgment matrix was constructed. Indexs’weight and maximum eigenvalueswas calculated by square root method, finishing hierarchical single sorting, whole sorting, and the consistency testing, the weights in all levels were determined.4. The empirical research, preliminary exploration.Applying the constructed "evaluation index system of postpartum care institutions" to a mature postpartum care institutions in Guangzhou as an example of empirical research to test their operability and feasibility. According to the results of the test evaluation to modify the evaluation index system.STATISTICS AND ANALYSISSPSS 13.0 software and Excel 2007 were used to analyze the data. The frequency and percentage were used for the description of the configuration and service content of postpartum care institutions, maternal general information,maternal attitudes towards confinement and postpartum care institutions and basic information of consulting experts; The mean and standard deviation were used to analyze maternal demands of postpartum care services; Adopting independent samples t-test to analyze the differences in needs of each dimension; The experts positive coefficient, authority coefficient, concentration of expert opinions, the level of coordination were used to test the reliability and representativeness of expert consultation;According to the means of importance assignment of indicators to determine the Saaty scale, judgment matrix was constructed. Indexs’weight was calculated by square root method, with hierarchical single sorting, whole sorting, and the consistency testing.RESULTS1. Service Status and maternal needs of postpartum care institutionStudy on service demands towards Institute of Postpartum Care shows 97.9% women think "doing the month" is very important,50.2% women are interested in Institute of Postpartum Care. They think the main three advantages are energy saving (61 percent), medical expertise and technology (61%) and avoidance of family conflicts (60%); The three major issues are high price (56%), lack of monitoring mechanism (33%) and unfamiliar environment and less family company (26%); 33 items of services demands over four points account for 78.6%, the three modules with highest scores are " cleaning services (4.64＋0.471)、newborn services(4.45±0.405)、 consultation service (4.41±0.533)Investigation on service status of postpartum care institution shows 11 basic maternal and child service items are provided by over 90% institution; in terms of staffing, medical beauty experts, postpartum rehabilitation and psychologist are of the lowest rates, respectively,55.6%,37.0%,29.6%; in terms of facility configuration, basic medical equipment is provided by only 18.5%.2. The results of constructing evaluation index system of postpartum care institutions by Delphi methodConsidering the purpose and the characteristics of this study, invitating 22 experts from five provinces, including Guangdong, Hubei, Sichuan, Taiwan, Hainan. There are 8 experts excellentin obstetric care,7 experts in obstetric management,5 in institutional management and 2 in infection control. Two survey questionnaires were issued 24 and 22 copies respectively, the effective questionnaires were 22 and 20 copies respectively, the effective rate was 91.7% and 90.9%. A total of 20 experts came up with 197 recommendations in the first round survey and 58 recommendations made by 8 experts in the second round consultation. respectively 90.9% and 95% of experts completed questionnaires within the time limit. Overall, experts showed high enthusiasm. Experts’authority coefficient on the evaluation index system is from 0.805 to 0.807 with an average of 0.806, which shows a high degree of authority of this study and the results are credible and reliable. Coordination coefficient of two rounds of consultation were 0.172 and 0.200 which is statistically significant (P<0.05), indicating the experts’opinion become consistent with a high degree of consistency towards contentThe screening criteria of the entries are the importance assigned mean were> 3.5, coefficient of variation<0.25, selectivity>70%.combining the opinions of experts, the evaluation index system was generalized into five areas, including administration, environment configuration and security management, sanitation and clean management, diet and nutrition management, maternal and child care with identified 129 indicators,covering the five first class indicators,22 second class indicators, 102 third class indicators.3. The weights results of evaluation index system of postpartum care institution determined by using AHP and expert scoring methodThe results show that the first class indicators include administration, environment configuration and security management, sanitation and clean management, diet and nutrition management, maternal and child care were weights 0.09,0.23,0.14,0.14,0.39 respectively. In second class indicators, five proportion "Environment and Security", "emergency, accident response," "maternal care", "baby care" large "Breastfeeding and guidance" weights 0.084,0.084,0.141,0.086 and 0.086 respectively. Upon examination, The results of single hierarchical sorting and total sorting has satisfactory consistency by test.4. The results of empirical evaluation system of postpartum care institutionsThe evaluation results showed that score was 78.9 which belongs to B level; Score rates of each primary index were greater than 60%, with the lowest score are the environment configuration and security management, sanitation and cleaning management,65.44% and 70.58% respectively. The lowest score rate in secondary index reaches 30.56%, a total of three secondary index were less than 60%, the three proportions with the lowest scores are "infection management and organization system", " response to emergency and accident" and "emergency care and referral," respectively 30.56%,31.7% and 38.33%.CONCLUSIONS1. Services of postpartum care institutions has become a trend and social demands, the postpartum care institutions investigated provide basic servicesDue to traditional practices, changes in values, enhanced economic capacity, maternal and child health services of postpartum care institution has been a trend and social needs. a majority of women is interested in postpartum care institution, the women show great demand in cleaning, baby care during postpartum, consulting services. Lack of price management and supervision mechanism is a major concern about postpartum care institutions. Postpartum care institutions should make full use of its resources provide targeted post-natal services based on the maternal needs. unified service standards and evaluation indicators of postpartum care institutions need to be built to improve service quality. Postpartum care institutions can provide the basic services, staff and equipments. But there are still some limitations, especially in the post-natal counseling and rehabilitation. Meanwhile, the services trend to be diverse.2. Developing initial evaluation index system of postpartum care institutions by expert consultation, upon examination, expert advice is relatively concentrated and the results are scientific and reliableEvaluation Index System constructed by Delphi method contains 5 first class indicators,22 second class indicators,102 third class indicators, consisting of the administration, environment configuration and security management, sanitation and clean management, diet and nutrition management, maternal and child care. The results are valid and reliable. Upon examination, expertspositive degree, degree of authority and the concentration of the expert opinions are quite ideal, the results are effective and reliable. However, as we can see from expert opinions, there is a controversy about the positioning of postpartum care institutions, some experts emphasized the importance of professional medical care to postpartum care institutions, while the other pay attention to its hotel-style daily care, which requires further exploration3. Using AHP method to set up the evaluation index weight, results are objective and scientificApplying AHP to further mathematical treatment about experts’subjective judgment make it more hierarchical, structured, quantitative, increasing the scientificity, logicality and accuracy of the evaluation index system. The weight results show that maternal and child care is a core evaluation criterion in the indexes.4. Evaluation index system makes a great significance on the Evaluation and Construction of postpartum care institutionEvaluation index system of postpartum care institutionsdeveloping by expert consultation method and AHP method was appliedfor test evaluation and tentative discovery, which showsthe evaluation indexes were comprehensive, purposefuland operable.But evaluation items still need further refinement. In the same time,test evaluation also reflects some problems of participated institution, such as first aid, infection control and quality control are not mature enough.