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Resource utilisation was estimated by constructing CABG process maps for each site based on observation of care and staff interviews.
Observation of care providers during ANC consultations and in labour rooms could have modified their behaviours, introducing bias in the observational results.
Non-participant observation of care on 11 acute hospital wards was supplemented by 39 semi-structured interviews with 35 family care-givers and four co-patients following discharge.
The overall objective of the study was to guide quality improvement activities for facility-based maternal and newborn care by determining the frequency and quality of key interventions through direct observation of care.
The data for this section of the findings come principally from observation of care and represents the greatest level of interpretation as it was not possible ask the patients themselves what was happening or why they were behaving in a particular way.
In this context, validity refers to the association between the identification of treatment with a particular strategy (e.g., diagnosis and procedure code combinations) and an often more difficult to obtain "gold standard," such as the direct observation of care or determination of addiction treatment by chart review.
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In future studies, matching observations of care by trained clinical observers to woman's ratings may provide more accurate measures of association between perceived quality of care and the objective quality of services received.
Inclusion criteria were met by 32,531 observations of care in 4,354 facilities.
For clinical quality, we used data from direct observations of care to calculate providers' adherence to evidence-based care guidelines.
Direct observations of care may therefore be of critical importance in assessing and improving care in this setting.
Seventy-two hofrs of non-participant observations of care were performed on the study wards.
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