Validity of a Medical Record in Measuring the Quality of Obstetric Services in Rural Clinics in Greater Masaka District, Uganda

Introduction

Despite improvements in health service coverage, quality of care (QoC) is often poor in low- and middle-income countries. To improve QoC, accurate measurements of healthcare processes are needed. The aim of this study was to estimate the validity of QoC data from patient medical records for childbirth deliveries by comparing them with direct clinical observation.

Methods

My study was part of a larger parent study of the effects of a healthcare QoC training program at six health facilities in Masaka district, Uganda. My study data were collected in two phases: 1) validation paired data of 321 observations plus the corresponding medical records collected; 2) evaluation data of 1,146 medical records of deliveries while the training intervention was being implemented. Sensitivity, specificity, positive predictive values, and negative predictive values were estimated as the bias parameters. Quantitative bias analysis was conducted by assigning these bias parameters. Prevalence ratio and odds ratio measured the parent study’s program efficacy.

Results

Medical records overestimated providers’ performance on quality indicators. The odds ratio of seven out of eleven indicators changed significantly; while the prevalence ratio of only one indicator varied.

Conclusion

The medical records for childbirth deliveries in Uganda demonstrated poor validity in measuring QoC compared with direct observation. Studies measuring QoC that rely on medical record data should be interpreted carefully, especially for obstetric and neonatal services. Meanwhile, poor record data showed a mixed result on the efficacy of the quality improvement program. Studies using the record data to evaluate the program efficacy should be done carefully, especially in low-resource settings.