Making childbirth safer: Promoting Evidence-based Care Name of presenter Prevention of Postpartum Hemorrhage Initiative (POPPHI) Project

Session Objectives By end of session, participants will be able to describe/define: The global maternal health situation Evidence-based care and rationales Objective for using clinical evidence

Maternal Mortality and Morbidity: Scope of Problem 180–200 million pregnancies per year 75 million unwanted pregnancies 50 million induced abortions and 20 million unsafe abortions 600,000 maternal deaths/year (1 per minute), 99% of which occur in developing countries 30 maternal morbidities for every 1 maternal death

Deaths Worldwide from Complications of Pregnancy and Childbirth

Principles of Basic Care Based on evidence Given by skilled providers in functioning healthcare system Provided in manner respectful of woman, her newborn and family, and their culture Individualized to meet unique needs of woman, newborn, and family

Objectives of Evidence-Based Care Promote practices based on best available evidence Encourage clinicians to: Value evidence above mere tradition or habit— “We’ve always done it this way.” Access and evaluate new clinical data as it becomes available Incorporate evidence into daily clinical practice (i.e., modify practices accordingly)

Objective of using clinical evidence To promote care based on best available evidence To encourage practitioners to develop their skills in obtaining, evaluating and incorporating evidence into daily clinical practice In order to achieve that, practitioners should understand and intellectually evaluate new clinical data as it becomes available

In an ideal world… The most effective care for every condition is known Every clinician has access to and understands most up-to-date evidence Every clinician practices most effective care s/he knows

In the real world Much of what should be known is not known Much that is known, is not known by most clinicians Clinicians often fail to practice what they know to be the most effective form of care

Evidence-based medicine is the systematic, scientific and explicit use of current best evidence in making decisions about the care of individual patients. Evidence-based medicine

Levels of Evidence and Grades of Recommendations

Importance of Rationales Practices should be based on firm rationales Provider should know why practice is important: What condition can be detected by conducting this part of examination? What condition may be prevented by giving this supplement? Understanding rationales helps provider focus assessment and care provision

Meta Analysis Is one tool that may allow useful information to be obtained from multiple studies Is systematic evaluation of collection of several studies which are similar in design, study populations and outcomes examined Combines data appropriately to find answer to important question in cumulative information in literature Is systematic review of medical literature

Measures of Statistical Significance: 95% Confidence Interval Confidence interval: Range in which true effect size can be found 95% chance that true effect size lies within 95% confidence interval If confidence interval overlaps 1.0, then there is a > 5% possibility that observed outcome difference is due to chance Very wide – results less believable Very narrow – more believable

Odds Ratio NoDifference Confidence Interval Results consistent with chance Reduced RiskIncreased Risk

Measures of Statistical Significance: p Value Conventionally set as 0.05 Equivalent to 5% Difference is significant if p value is less than 0.05 (< 0.05) Means that there is less than a 5% chance that the result obtained is due to chance, or 95% certain that result obtained by the intervention is true

Summary Quality basic care is: Based on evidence and rationales Evidence-based medicine should be used to set a standard of care New data should be evaluated critically to determine whether to change standards Given by skilled provider in functioning healthcare system

References Hulley SB and SR Cummings Designing Clinical Research: An epidemiological approach. Williams and Wilkins: Baltimore, Maryland.