Pub Date : 1992-01-01DOI: 10.1093/OXFORDJOURNALS.INTQHC.A036692
E. Reerink
{"title":"Quality assurance and health informatics.","authors":"E. Reerink","doi":"10.1093/OXFORDJOURNALS.INTQHC.A036692","DOIUrl":"https://doi.org/10.1093/OXFORDJOURNALS.INTQHC.A036692","url":null,"abstract":"","PeriodicalId":77341,"journal":{"name":"Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care","volume":"4 1 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"1992-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/OXFORDJOURNALS.INTQHC.A036692","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61010283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1992-01-01DOI: 10.1093/OXFORDJOURNALS.INTQHC.A036707
J. Smith, C. Sanderson
All patients attending 10 general medical and general surgical outpatient clinics at a provincial teaching hospital were surveyed during a 1-week period. Questionnaires administered and completed by the patients at the time of the visit were used to establish the factors most closely associated with patients feeling that their consultations had been "very worthwhile". These were: consultations lasting more than 10 min, having received advice from a specialist and having been reassured. The study may provide a basis for a process of medical audit in outpatient departments and, thus, more appropriate services.
{"title":"What makes outpatient attendance worthwhile for patients?","authors":"J. Smith, C. Sanderson","doi":"10.1093/OXFORDJOURNALS.INTQHC.A036707","DOIUrl":"https://doi.org/10.1093/OXFORDJOURNALS.INTQHC.A036707","url":null,"abstract":"All patients attending 10 general medical and general surgical outpatient clinics at a provincial teaching hospital were surveyed during a 1-week period. Questionnaires administered and completed by the patients at the time of the visit were used to establish the factors most closely associated with patients feeling that their consultations had been \"very worthwhile\". These were: consultations lasting more than 10 min, having received advice from a specialist and having been reassured. The study may provide a basis for a process of medical audit in outpatient departments and, thus, more appropriate services.","PeriodicalId":77341,"journal":{"name":"Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care","volume":"4 2 1","pages":"125-32"},"PeriodicalIF":0.0,"publicationDate":"1992-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/OXFORDJOURNALS.INTQHC.A036707","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61010482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1992-01-01DOI: 10.1093/OXFORDJOURNALS.INTQHC.A036711
F. Buntinx, J. Knottnerus, H. Crebolder, G. Essed
Three different forms of feedback designed to improve the sampling quality of cervical smears were tested in a randomized controlled trial among 179 physicians. The reactions of the doctors to the various interventions are reported as they appeared from their answers in a questionnaire. The influence of the interventions on the employed sampling technique is described on the basis of their answers to a telephone inquiry. The inclusion in laboratory protocols of an evaluation of the sampling quality of the submitted smears was largely appreciated, as was specific advice offered on indication. Monthly overviews comparing the performance of the individual doctor to that of his peers were esteemed by three out of four. Further information, help or training was requested more frequently than average by physicians obtaining inadequately sampled smears relatively often. The number of doctors using the combined spatula and Cytobrush method as sampling technique doubled during the study period.
{"title":"Reactions of doctors to various forms of feedback designed to improve the sampling quality of cervical smears.","authors":"F. Buntinx, J. Knottnerus, H. Crebolder, G. Essed","doi":"10.1093/OXFORDJOURNALS.INTQHC.A036711","DOIUrl":"https://doi.org/10.1093/OXFORDJOURNALS.INTQHC.A036711","url":null,"abstract":"Three different forms of feedback designed to improve the sampling quality of cervical smears were tested in a randomized controlled trial among 179 physicians. The reactions of the doctors to the various interventions are reported as they appeared from their answers in a questionnaire. The influence of the interventions on the employed sampling technique is described on the basis of their answers to a telephone inquiry. The inclusion in laboratory protocols of an evaluation of the sampling quality of the submitted smears was largely appreciated, as was specific advice offered on indication. Monthly overviews comparing the performance of the individual doctor to that of his peers were esteemed by three out of four. Further information, help or training was requested more frequently than average by physicians obtaining inadequately sampled smears relatively often. The number of doctors using the combined spatula and Cytobrush method as sampling technique doubled during the study period.","PeriodicalId":77341,"journal":{"name":"Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care","volume":"4 2 1","pages":"161-6"},"PeriodicalIF":0.0,"publicationDate":"1992-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/OXFORDJOURNALS.INTQHC.A036711","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61010536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1992-01-01DOI: 10.1093/OXFORDJOURNALS.INTQHC.A036695
C. Veit, A. Tecklenburg
Computing systems for quality assessment in the operative departments, in anaesthesia and intensive care were developed at the Altona General Hospital, Hamburg. The main goals were to support quality assurance as a tool for the medical staff which they can use actively in their routine work and to reorganize uneconomical forms of clinical data handling. The most important characteristics of the tools presented here are flexibility of the databases and applications, openness to individual configurations and integration of quality assessment, activity audits and clinical routine under the primacy of medical documentation. Research is aimed at new forms of medical documentation, problem-oriented presentation and focusing of clinical data in the context of quality assurance programs.
{"title":"Computing tools for quality assurance.","authors":"C. Veit, A. Tecklenburg","doi":"10.1093/OXFORDJOURNALS.INTQHC.A036695","DOIUrl":"https://doi.org/10.1093/OXFORDJOURNALS.INTQHC.A036695","url":null,"abstract":"Computing systems for quality assessment in the operative departments, in anaesthesia and intensive care were developed at the Altona General Hospital, Hamburg. The main goals were to support quality assurance as a tool for the medical staff which they can use actively in their routine work and to reorganize uneconomical forms of clinical data handling. The most important characteristics of the tools presented here are flexibility of the databases and applications, openness to individual configurations and integration of quality assessment, activity audits and clinical routine under the primacy of medical documentation. Research is aimed at new forms of medical documentation, problem-oriented presentation and focusing of clinical data in the context of quality assurance programs.","PeriodicalId":77341,"journal":{"name":"Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care","volume":"4 1 1","pages":"3-8"},"PeriodicalIF":0.0,"publicationDate":"1992-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/OXFORDJOURNALS.INTQHC.A036695","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61010314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1992-01-01DOI: 10.1093/OXFORDJOURNALS.INTQHC.A036699
I. Aramini, P. Morosini, E. Ricci, S. Ratto, M. Petrini, A. Banchero
A formal variability study has been carried out in a geriatric hospital in Genoa, Italy, in order to estimate the degree of agreement between geriatricians in disability and functional assessment, recommendation for rehabilitation treatments, need for mobility and daily activities aids, and decisions about optimal place of treatment (own home, sheltered housing, old peoples' home, nursing home). Sixteen long-stay geriatric patients, average age 83 years, were visited by eight geriatricians, a patient receiving from two to five visits. The participating physicians could visit the patients at their leisure, had access to clinical records and could interview a nurse well acquainted with the patient. A marked variability was observed for most items, e.g. the agreement concerning the recommendation for individual physiotherapy was only 52%. The results of this study may not be generalized to other situations and to actual practice; however, variability studies of this kind, that assess diagnosis habits, treatment and managerial decisions at the same time, may be useful to pinpoint the most important problems and to stimulate professionals' participation in proper Quality Assurance projects.
{"title":"Variability among geriatricians in the evaluation of functional disabilities and rehabilitation needs of the elderly.","authors":"I. Aramini, P. Morosini, E. Ricci, S. Ratto, M. Petrini, A. Banchero","doi":"10.1093/OXFORDJOURNALS.INTQHC.A036699","DOIUrl":"https://doi.org/10.1093/OXFORDJOURNALS.INTQHC.A036699","url":null,"abstract":"A formal variability study has been carried out in a geriatric hospital in Genoa, Italy, in order to estimate the degree of agreement between geriatricians in disability and functional assessment, recommendation for rehabilitation treatments, need for mobility and daily activities aids, and decisions about optimal place of treatment (own home, sheltered housing, old peoples' home, nursing home). Sixteen long-stay geriatric patients, average age 83 years, were visited by eight geriatricians, a patient receiving from two to five visits. The participating physicians could visit the patients at their leisure, had access to clinical records and could interview a nurse well acquainted with the patient. A marked variability was observed for most items, e.g. the agreement concerning the recommendation for individual physiotherapy was only 52%. The results of this study may not be generalized to other situations and to actual practice; however, variability studies of this kind, that assess diagnosis habits, treatment and managerial decisions at the same time, may be useful to pinpoint the most important problems and to stimulate professionals' participation in proper Quality Assurance projects.","PeriodicalId":77341,"journal":{"name":"Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care","volume":"4 1 1","pages":"69-76"},"PeriodicalIF":0.0,"publicationDate":"1992-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/OXFORDJOURNALS.INTQHC.A036699","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61010411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1992-01-01DOI: 10.1093/OXFORDJOURNALS.INTQHC.A036715
C. Favaretti, A. Mariotto
A quality improvement system has been established in 1989 in the hospital network of Padua and its organization is described. Three selected experiences are reported. (1) Appropriateness of the use of human albumin. After the assessment of the clinical policy, new guidelines were experimentally introduced and an evaluation after 3 months has shown a decrease of the total number of prescriptions (25%) and of inappropriate indications (9% vs 40.1%). (2) Urinary Tract Infections (UTI) and indwelling catheterization. The study showed 49% of conditions related to UTI and some corrigible inadequacies in the process of care: 37.2% of indications were probably not justified; 40% of patients who did not undergo urineculture had indications and 13% who underwent urineculture had no indications to the test. Guidelines for appropriate indications and a continuing education programme have been introduced. (3) Falls by hospitalized patients. The patient fall rate was 0.3/1000. As the reporting system showed inaccuracies (for example, the severity of injury was not collected in 34% of cases), a new notification form was introduced in 1991.
{"title":"The quality improvement system in the hospitals of Padua (Italy).","authors":"C. Favaretti, A. Mariotto","doi":"10.1093/OXFORDJOURNALS.INTQHC.A036715","DOIUrl":"https://doi.org/10.1093/OXFORDJOURNALS.INTQHC.A036715","url":null,"abstract":"A quality improvement system has been established in 1989 in the hospital network of Padua and its organization is described. Three selected experiences are reported. (1) Appropriateness of the use of human albumin. After the assessment of the clinical policy, new guidelines were experimentally introduced and an evaluation after 3 months has shown a decrease of the total number of prescriptions (25%) and of inappropriate indications (9% vs 40.1%). (2) Urinary Tract Infections (UTI) and indwelling catheterization. The study showed 49% of conditions related to UTI and some corrigible inadequacies in the process of care: 37.2% of indications were probably not justified; 40% of patients who did not undergo urineculture had indications and 13% who underwent urineculture had no indications to the test. Guidelines for appropriate indications and a continuing education programme have been introduced. (3) Falls by hospitalized patients. The patient fall rate was 0.3/1000. As the reporting system showed inaccuracies (for example, the severity of injury was not collected in 34% of cases), a new notification form was introduced in 1991.","PeriodicalId":77341,"journal":{"name":"Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care","volume":"4 2 1","pages":"97-104"},"PeriodicalIF":0.0,"publicationDate":"1992-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/OXFORDJOURNALS.INTQHC.A036715","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61010584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1992-01-01DOI: 10.1093/OXFORDJOURNALS.INTQHC.A036705
C. Quantin, L. Dusserre, A. M. Montaud, C. Mottot, J. Feldman
Although many reliability studies on cervical cytology have been carried out, measurements of sensitivity and specificity have rarely been made since biopsies are not often performed on patients with a negative smear result. This screening assessment was performed over 3 years, using a database of 230,167 smears from 177,051 women. It would seem that cervical cytology has a high specificity (over 99%) but a relatively low sensitivity (61%). Values for sensitivity (exceeding 95%) and specificity (exceeding 99%) for invasive carcinoma should be regarded as reasonably accurate as all incident cases of symptomatic cervical carcinoma are recorded in the Burgundy register. The sensitivity (57%) for pre-invasive lesions is underestimated while their prevalence is overestimated: the lack of organized screening leads to the loss of prevalent cases. The predictive value of a positive smear is 76% for moderate-severe dysplasia, 85% for in situ carcinoma and over 95% for invasive carcinoma.
{"title":"A model for quality assessment in cervical cytology used as a screening test.","authors":"C. Quantin, L. Dusserre, A. M. Montaud, C. Mottot, J. Feldman","doi":"10.1093/OXFORDJOURNALS.INTQHC.A036705","DOIUrl":"https://doi.org/10.1093/OXFORDJOURNALS.INTQHC.A036705","url":null,"abstract":"Although many reliability studies on cervical cytology have been carried out, measurements of sensitivity and specificity have rarely been made since biopsies are not often performed on patients with a negative smear result. This screening assessment was performed over 3 years, using a database of 230,167 smears from 177,051 women. It would seem that cervical cytology has a high specificity (over 99%) but a relatively low sensitivity (61%). Values for sensitivity (exceeding 95%) and specificity (exceeding 99%) for invasive carcinoma should be regarded as reasonably accurate as all incident cases of symptomatic cervical carcinoma are recorded in the Burgundy register. The sensitivity (57%) for pre-invasive lesions is underestimated while their prevalence is overestimated: the lack of organized screening leads to the loss of prevalent cases. The predictive value of a positive smear is 76% for moderate-severe dysplasia, 85% for in situ carcinoma and over 95% for invasive carcinoma.","PeriodicalId":77341,"journal":{"name":"Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care","volume":"4 2 1","pages":"105-13"},"PeriodicalIF":0.0,"publicationDate":"1992-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/OXFORDJOURNALS.INTQHC.A036705","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61010452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1992-01-01DOI: 10.1093/OXFORDJOURNALS.INTQHC.A036697
U. Ruiz, K. Acedo, R. Buenaventura, J. Coll, S. Coronado, A. Rivero, S. Rocillo
A Total Quality Management Programme for the Spanish Health Care System was set in motion in 1986. The first phase of the programme covers three areas: (1) information sources, (2) training, (3) Total Quality activities, through a cascade of four coordinated projects. The first one defines a basic nucleus of patient information and established two national standards: (a) a minimum basic data set, (b) the use of an ICD-9-CM Spanish translation for codification of diagnoses and procedures. The second is an open demonstration project implementing these two standards in National Health Service hospitals and carrying out intensive training on ICD-9-CM codifiers. The third project encompasses two pilot studies on case-mix measurements systems and cost analysis framework. Through the fourth project concepts, methods and tools for Total Quality Management are developed, setting up specific working groups on clinical and organizational indicators for hospitals and primary health care.
{"title":"Implementing total quality management in the Spanish health care system.","authors":"U. Ruiz, K. Acedo, R. Buenaventura, J. Coll, S. Coronado, A. Rivero, S. Rocillo","doi":"10.1093/OXFORDJOURNALS.INTQHC.A036697","DOIUrl":"https://doi.org/10.1093/OXFORDJOURNALS.INTQHC.A036697","url":null,"abstract":"A Total Quality Management Programme for the Spanish Health Care System was set in motion in 1986. The first phase of the programme covers three areas: (1) information sources, (2) training, (3) Total Quality activities, through a cascade of four coordinated projects. The first one defines a basic nucleus of patient information and established two national standards: (a) a minimum basic data set, (b) the use of an ICD-9-CM Spanish translation for codification of diagnoses and procedures. The second is an open demonstration project implementing these two standards in National Health Service hospitals and carrying out intensive training on ICD-9-CM codifiers. The third project encompasses two pilot studies on case-mix measurements systems and cost analysis framework. Through the fourth project concepts, methods and tools for Total Quality Management are developed, setting up specific working groups on clinical and organizational indicators for hospitals and primary health care.","PeriodicalId":77341,"journal":{"name":"Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care","volume":"4 1 1","pages":"43-59"},"PeriodicalIF":0.0,"publicationDate":"1992-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/OXFORDJOURNALS.INTQHC.A036697","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61010377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1992-01-01DOI: 10.1093/OXFORDJOURNALS.INTQHC.A036698
W. Picco, L. Pinna Pintor, G. Baruzzo, O. Pistono, F. Triumbari, P. Pinna Pintor
An integrated informatic system may have an important role in identifying and reducing those errors which affect the reliability of laboratory results. The present work reports on the development of a system that, by means of a computer connected with laboratory instrumentation, allows monitoring of global error (bias, random, gross) using classical statistical quality control systems, integrated by auxiliary methods built on a database stored in the computer. These methods succeeded in greatly reducing bias and random error in the most frequent laboratory tests. Further methods to find, quantify, and reduce the gross and extra-analytical errors are under development.
{"title":"Quality control of laboratory results in real time.","authors":"W. Picco, L. Pinna Pintor, G. Baruzzo, O. Pistono, F. Triumbari, P. Pinna Pintor","doi":"10.1093/OXFORDJOURNALS.INTQHC.A036698","DOIUrl":"https://doi.org/10.1093/OXFORDJOURNALS.INTQHC.A036698","url":null,"abstract":"An integrated informatic system may have an important role in identifying and reducing those errors which affect the reliability of laboratory results. The present work reports on the development of a system that, by means of a computer connected with laboratory instrumentation, allows monitoring of global error (bias, random, gross) using classical statistical quality control systems, integrated by auxiliary methods built on a database stored in the computer. These methods succeeded in greatly reducing bias and random error in the most frequent laboratory tests. Further methods to find, quantify, and reduce the gross and extra-analytical errors are under development.","PeriodicalId":77341,"journal":{"name":"Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care","volume":"4 1 1","pages":"61-7"},"PeriodicalIF":0.0,"publicationDate":"1992-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/OXFORDJOURNALS.INTQHC.A036698","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61010394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1992-01-01DOI: 10.1093/OXFORDJOURNALS.INTQHC.A036706
A. Vleugels, A. Bekaert
The Flemish Centre for the Study of Perinatal Epidemiology was formally established in 1986. Its objectives are the promotion of perinatal epidemiology and the study of maternal and perinatal mortality and morbidity. One of the means to accomplish these objectives was the creation of a databank of perinatal medicine. The registry at present covers almost 80% of all deliveries in Flanders. The registry indicates a maternal death rate of 5.8/100,000 living births whereas the Belgian official national statistics indicate a maternal death rate of 2.8/100,000. This means that either the matter is under reported at the national level or there is a real problem in the Flemish part of the country. The perinatal death rate varies among the participating services form 3.9 to 22.4%.
{"title":"The Flemish Centre for the Study of Perinatal Epidemiology and its registry.","authors":"A. Vleugels, A. Bekaert","doi":"10.1093/OXFORDJOURNALS.INTQHC.A036706","DOIUrl":"https://doi.org/10.1093/OXFORDJOURNALS.INTQHC.A036706","url":null,"abstract":"The Flemish Centre for the Study of Perinatal Epidemiology was formally established in 1986. Its objectives are the promotion of perinatal epidemiology and the study of maternal and perinatal mortality and morbidity. One of the means to accomplish these objectives was the creation of a databank of perinatal medicine. The registry at present covers almost 80% of all deliveries in Flanders. The registry indicates a maternal death rate of 5.8/100,000 living births whereas the Belgian official national statistics indicate a maternal death rate of 2.8/100,000. This means that either the matter is under reported at the national level or there is a real problem in the Flemish part of the country. The perinatal death rate varies among the participating services form 3.9 to 22.4%.","PeriodicalId":77341,"journal":{"name":"Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care","volume":"4 2 1","pages":"115-24"},"PeriodicalIF":0.0,"publicationDate":"1992-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/OXFORDJOURNALS.INTQHC.A036706","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61010469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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