نوع مقاله : مقاله پژوهشی
نویسندگان
1 دانشیار، مدیریت خدمات بهداشتی درمانی، مرکز تحقیقات مدیریت خدمات بهداشتی و درمانی تبریز (NPMC)، دانشکده‌ی مدیریت و اطلاع‌رسانی پزشکی، دانشگاه علوم پزشکی تبریز، تبریز، ایران
2 دانشجوی دکتری، مدیریت خدمات سلامت، دانشکده مدیریت و انفورماتیک پزشکی، کمیته تحقیقات دانشجویی، دانشگاه علوم پزشکی تبریز، تبریز، ایران
3 استادیار آمار زیستی، مرکز تحقیقات آموزش پزشکی، دانشکده بهداشت، دانشگاه علوم پزشکی تبریز علوم، تبریز، ایران
4 دستیار، بیهوشی، دانشکده پزشکی، دانشگاه علوم پزشکی تبریز، تبریز، ایران
5 دستیار، روانپزشکی، دانشکده پزشکی، دانشگاه علوم پزشکی تبریز، تبریز، ایران
چکیده
مقدمه: ارزیابی کیفیت یکی از روش‌های مفید در ارتقای کیفیت خدمات سلامت می‌باشد، برای این امر جامعیت کیفیت و دقت داده‌های جمع‌آوری شده از اهمیت بالایی در فرایند ارزیابی برخوردار است. هدف از مطالعه‌ی حاضر، تعیین میزان تطابق داده‌های جمع‌آوری شده درباره‌ی کیفیت فنی مراقبت‌های دوران بارداری از دو منبع گیرندگان خدمات و پرونده‌ی خانوار بود.
روش بررسی: مطالعه‌ی حاضر یک مطالعه توصیفی- مقطعی بود که با مشارکت 185 نفر از زنان باردار که به صورت تصادفی انتخاب شده بودند از 40 مرکز بهداشتی درمانی و پایگاه بهداشتی شهر تبریز در سال 1389 انجام گرفت. داده‌های مربوط به کیفیت فنی از دو منبع کاملاً مستقل (مشتری خدمت و اطلاعات ثبت شده در پرونده‌ی گیرنده‌ی خدمت) جمع‌آوری شد. ابزار جمع‌آوری داده‌ها، پرسش‌نامه‌ی محقق ساخته‌ای بود که روایی پرسش‌نامه توسط 10 نفر از صاحب‌نظران بررسی و بعد از اعمال نظرات آنان مورد تأیید قرار گرفت. پایایی پرسش‌نامه با استفاده از همسانی درونی تأیید گردید (748/0 = α). برای ارزیابی تطابق تک تک آیتم‌ها در دو منبع اطلاعاتی، از شاخص کاپای وزنی (Weighted Kappa) و ICC (Intraclass correlation coeficient) استفاده شد. داده‌ها با نرم‌افزار SPSS نسخه‌ی 17 و STATA 10 تحلیل گردید.
یافته‌ها: توافق بین داده‌های حاصل از پرونده و اظهارات مادران باردار در مورد بسیاری از خدمات، در حد ضعیفی بود (4/0 > Kappa) و تنها در مورد برخی خدمات همچون تعداد مراقبت‌ها (56/0 = Kappa) و اندازه‌گیری وزن و فشار خون (55/0 = Kappa) توافق متوسط و در مورد زمان تشکیل پرونده (903/0–824/0:CI95% ، 87/0 = P) و زمان اطلاع از بارداری (962/0–931/0:CI95% ، 95/0 = P) توافق قوی وجود داشت.
نتیجه‌گیری: ارزیابی خدماتی چون مراقبت‌ها و آموزش‌های دوران بارداری بهتر است از طریق داده‌های حاصل از اظهارات مادران باردار صورت گیرد، چرا که این ارزیابی می‌تواند نشان دهنده‌ی نوعی ارزیابی پیامد باشد. به نظر می‌رسد نتیجه‌ی مراقبت‌ها و آموزش‌های ارایه شده قابل دریافت از زبان گیرندگان خدمات باشد. در مجموع به علت نقص در ثبت خدمات، استفاده از نظرات مشتری‌ها درباره‌ی خدماتی که دریافت کرده‌اند می‌تواند معتبرتر از پرونده‌های بهداشتی باشد.
کلیدواژه‌ها
عنوان مقاله [English]
Agreement between Costumers Reported Data and Medical Records in Evaluating Technical Quality of Prenatal Care*
نویسندگان [English]
- Jafar Sadegh Tabrizi 1
- Kamal Gholipour 2
- Mohammad Asghari Jafarabadi 3
- Mojtaba Mohammad Zadeh 4
- Mostafa Farahbakhsh 5
1 Associate Professor, Health Services Management, Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
2 PhD Candidate, Health Services Management, School of Management and Medical Informatics, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
3 Assistant Professor, Biostatistics, Medical Education Research Center, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran
4 Resident, Anesthesiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
5 Resident, Psychiatry, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
چکیده [English]
Introduction: Evaluation is a suitable way to improve the healthcare quality. At the other hand, quality
and validity of information is an important factor in this process. The aim of this study was to assess
adjustment and agreement between medical records data and pregnant women reported healthcare data in
prenatal maternity care.
Methods: A cross-sectional study was conducted on 185 pregnant women who were selected randomly
and received maternity care from 40 urban health centers and health posts in Tabriz, Iran. Technical
quality data were obtained from two different sources medical record and pregnant women reported data.
Questionnaire’s content validity was reviewed and confirmed by 10 experts and its reliability was
confirmed based on Cronbach's alpha (α = 0.748). Weighted Kappa and ICC (intra-class correlation
coefficient) were used to analyze each item. Data were analyzed using the STATA ver.10 and SPSS
ver.17 statistical packages.
Results: There was a weak agreement between the two data sources. Only in some services there was a
moderate agreement such as number of care (Kappa = 0.56), blood pressure and weight measurement
(Kappa = 0.55). In registration time to health center (P = 0.95, 95%CI 0.931-0.962) and awareness of
pregnancy (P = 0.87, 95%CI 0.824-0.903) there was a strong agreement between medical document and
customers reported data.
Conclusion: For some services such as pregnancy education, it is preferred to use pregnant women
reported data, because such data are a form of output assessment. Furthermore, due to a defect in the
recording services, customers’ reported data were more valid than the health records.
کلیدواژه‌ها [English]
- Medical Records
- Prenatal Care
- Health Care Quality Assessment
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