Improving Effective Prenatal Care for New Obstetric Patients Using a Standardized Intake Template and Pregnancy Risk Calculator.

Abstract

Introduction: Kenya has the 16^th highest maternal mortality rate and the 58^th highest infant mortality rate in the world. Most of these deaths are preventable and attributed to inadequate prenatal care. A chart audit at Africa Inland Church Kijabe Hospital revealed significant gaps in care at the initial prenatal visit. This project aimed to increase effective prenatal care for all new obstetric patients seen at the Maternal and Child Health Clinic to 75% within 8 weeks.

Methods: This quality improvement initiative consisted of two core interventions implemented over four Plan-Do-Study-Act cycles. Each 2-week cycle was guided by a test of change, and the data were analyzed at the end of each cycle. The first core intervention was implementing a new obstetric standard of care, based on 32 evidence-based guidelines from the World Health Organization and the Kenya Ministry of Health, which were embedded into a standardized intake template at the initial prenatal visit. The second core intervention was implementing a pregnancy risk calculator, using the Alberta Antenatal Risk Assessment, to classify each new obstetric patient's pregnancy as low, moderate, or high risk.

Results: This project achieved its aim statement and increased effective prenatal care from 21% to 77% in 8 weeks. Implementing the standardized intake template increased the mean standard-of-care score from 42% to 83%, with the greatest improvements seen in documenting a complete medical history and ordering prenatal labs. The number of high- or moderate-risk pregnancies identified was 33%, providing an opportunity for timely referral to the high-risk pregnancy clinic.

Conclusion: The tools used in this quality improvement initiative provided a low-cost method to promote high-quality prenatal care. The standardized intake template can be adapted to other countries and contexts; further studies are needed to evaluate its impact on birth outcomes. This is the first known report of the implementation of a pregnancy risk calculator in Kenya to identify high-risk pregnancies. Further research is needed to analyze its effectiveness and to develop and validate a pregnancy risk calculator for sub-Saharan Africa.