American Journal of Industrial Engineering
ISSN (Print): 2377-4320 ISSN (Online): 2377-4339 Website: http://www.sciepub.com/journal/ajie Editor-in-chief: Ajay Verma
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American Journal of Industrial Engineering. 2021, 8(1), 9-17
DOI: 10.12691/ajie-8-1-2
Open AccessArticle

Monitoring Maternal Healthcare Performance in Hospital Setting Using a Multi-stage Bayesian Network Approach

Ridwan Al Aziz1, Hasan Symum2, , Nafisa Mahbub3 and Abdullahil Azeem1

1Department of Industrial and Production Engineering, Bangladesh University of Engineering and Technology, Dhaka, Bangladesh

2Department of Industrial and Production Engineering, Dhaka University of Engineering and Technology, Gazipur, Bangladesh

3Department of Industrial and Systems Engineering, State University of New York at Buffalo, Buffalo, New York, United States

Pub. Date: December 12, 2021

Cite this paper:
Ridwan Al Aziz, Hasan Symum, Nafisa Mahbub and Abdullahil Azeem. Monitoring Maternal Healthcare Performance in Hospital Setting Using a Multi-stage Bayesian Network Approach. American Journal of Industrial Engineering. 2021; 8(1):9-17. doi: 10.12691/ajie-8-1-2

Abstract

Most studies on healthcare process monitoring focus on surveillance end-stage clinical outcomes and thus may ignore interaction from earlier stages. For a complex multi-stage healthcare process such as maternal delivery in hospital settings, ignoring what occurs in earlier stages of the procedure may inadvertently lead to poorer outcomes, if continued. Therefore, this study employs a holistic approach to developing a Bayesian network-based monitoring process by considering interaction among multiple maternal healthcare stages. A total of fourteen outcome variables, three process variables, and eight risk factors from antepartum and subsequent periods are considered. Data are obtained from the Dhaka Medical College Hospital and Rajshahi Medical hospitals of Bangladesh from March 2017 to May 2017. The Bayesian network parameters were estimated using logistic regression models for each outcome variable and then simulated for monitoring by multi-stage exponentially weighted moving average control charts. Our findings demonstrate that different variables of the antepartum period and other new variables incorporated in this paper are crucial in evaluating the risk for pregnant mothers and infants. This corroborates the significance of tracing back to earlier stages to identify the causes for an abnormal outcome and provides a clearer understanding of the potential sources of excess variation that lead to a shift in final stage outcomes.

Keywords:
maternal health childbirth predictive modeling Bayesian network control chart

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Karlström, A., Nystedt, A. and Hildingsson, I., “The meaning of a very positive birth experience: Focus groups discussions with women”, BMC Pregnancy and Childbirth, 15 (1). 1-8. 2015.
 
[2]  Hirshberg, A. and Srinivas, S.K., “Epidemiology of maternal morbidity and mortality”, Seminars in Perinatology, 41 (6). 332-337. 2017.
 
[3]  Miller, S., Abalos, E., Chamillard, M., Ciapponi, A., Colaci, D., Comandé, D., Diaz, V., Geller, S., Hanson, C., Langer, A. and Manuelli, V., “Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide”, Lancet, 388. 2176-2192. 2016.
 
[4]  Beck, S., Wojdyla, D., Say, L., Betran, A., Merialdi, M., Requejo, J., Rubens, C., Menon, R. and Look, P., “The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity”, Bulletin of the World Health Organization, 88. 31-38. 2010.
 
[5]  Hug, L., Alexander, M., You, D. and Alkema, L., “National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis”, The Lancet Global Health, 7 (6). e710-e720. 2019.
 
[6]  Mehra, T., Muller, C.T.B., Volbracht, J., Seifert, B. and Moos, R., “Predictors of high profit and high deficit outliers under SwissDRG of a tertiary care center”, PLoS One, 10. 1-18. 2015.
 
[7]  Regional Committee for the Western Pacific, 067, “Sustainable development goals (‎Resolution)”, WHO Regional Office for the Western Pacific. Available online: https://apps.who.int/iris/handle/10665/259307 (accessed on Oct 1, 2021).
 
[8]  Anwar, I., Nababan, H.Y., Mostari, S., Rahman, A. and Khan, J.A.M., “Trends and Inequities in Use of Maternal Health Care Services in Bangladesh, 1991-2011”, PLoS One, 10. e0120309. 2015.
 
[9]  Rajia, S., Sabiruzzaman, M., Islam, M.K., Hossain, M.G. and Lestrel, P.E., “Trends and future of maternal and child health in Bangladesh”, PLoS One, 14. e0211875. 2019.
 
[10]  UNFPA Bangladesh Annual Report 2019, Available online: https://bangladesh.unfpa.org/ sites/default/files/pub-pdf/UNFPA Bangladesh - Annual Report 2019 - eVersion - Low Resolution.pdf (accessed on Oct 1, 2021).
 
[11]  10 infants and children die within 10 hours at Bangladesh hospital. CBS News. 2015. Available online: https://www.cbsnews.com/news/10-infants-and-children-die-within-10-hours-at-bangladesh-hospital/ (accessed on Oct 1, 2021).
 
[12]  Morton, A.P., “The use of statistical process control methods in monitoring clinical performance”, International Journal for Quality in Health Care, 15 (4). 361-362. 2003.
 
[13]  Hubig, L., Lack, N. and Mansmann, U., “Statistical process monitoring to improve quality assurance of inpatient care”, BMC Health Services Research, 20. 1-14. 2020.
 
[14]  Makary, M.A. and Daniel, M., “Medical error-the third leading cause of death in the US”, BMJ, 353, 2016.
 
[15]  Thor, J., Lundberg, J., Ask, J., Olsson, J., Carli, C., Härenstam, K.P. and Brommels, M., “Application of statistical process control in healthcare improvement: Systematic review”, BMJ Quality and Safety, 16 (5). 387-399. 2007.
 
[16]  Suman, G. and Prajapati, D., “Control chart applications in healthcare: a literature review”, International Journal of Metrology and Quality Engineering, 9. 5. 2018.
 
[17]  Saturno-Hernández, P.J., Martínez-Nicolás, I., Moreno-Zegbe, E., Fernández-Elorriaga, M. and Poblano-Verástegui, O., “Indicators for monitoring maternal and neonatal quality care: A systematic review”, BMC Pregnancy and Childbirth, 19. 1-11. 2019.
 
[18]  Tsung, F., Li, Y. and Jin, M., “Statistical process control for multistage manufacturing and service operations: A review and some extensions”, International Journal of Services Operations and Informatics, 3 (2). 191-204. 2008.
 
[19]  Sibanda, N., “Graphical model-based O/E control chart for monitoring multiple outcomes from a multi-stage healthcare procedure”, Statistical Methods in Medical Research, 25 (5). 2274-2293. 2016.
 
[20]  Goffman, D., Madden, R.C., Harrison, E.A., Merkatz, I.R. and Chazotte, C., “Predictors of maternal mortality and near-miss maternal morbidity”, Journal of Perinatology, 27 (10). 597-601. 2007.
 
[21]  Scannapieco, F.A., Bush, R.B. and Paju, S., “Periodontal Disease as a Risk Factor for Adverse Pregnancy Outcomes. A Systematic Review”, Annals of Periodontology, 8 (1). 70-78. 2003.
 
[22]  Zhu, J., Ge, Z., Song, Z., Zhou, L. and Chen, G., “Large-scale plant-wide process modeling and hierarchical monitoring: A distributed Bayesian network approach”, Journal of Process Control, 65. 91-106. 2018.
 
[23]  Amin, M.T., Khan, F. and Imtiaz, S., “Fault detection and pathway analysis using a dynamic Bayesian network”, Chemical Engineering Science, 195. 777-790. 2019.
 
[24]  Tang, A., Sun, J., Hu, X. and Castagliola, P., “A new nonparametric adaptive EWMA control chart with exact run length properties”, Computers & Industrial Engineering, 130. 404-419. 2019.
 
[25]  Prevalence of anemia among pregnant women (%) | Data Available online: https://data.worldbank.org/ indicator/SH.PRG.ANEM?name_desc=false (accessed on Mar 12, 2021).
 
[26]  Mistry, S.K., Jhohura, F.T., Khanam, F., Akter, F., Khan, S., Yunus, F.M., Hossain, M.B., Afsana, K., Haque, M.R. and Rahman, M., “An outline of anemia among adolescent girls in Bangladesh: Findings from a cross-sectional study”, BMC Hematology, 17. 1-8. 2017.
 
[27]  Lindström, E., Hossain, M. B., Lönnerdal, B. O., Raqib, R., El Arifeen, S., and EKSTRÖM, E. C., “Prevalence of anemia and micronutrient deficiencies in early pregnancy in rural Bangladesh, the MINIMat trial”, Acta obstetricia et gynecologica Scandinavica, 90 (1). 47-56. 2011.
 
[28]  Poon, L.C., McIntyre, H.D., Hyett, J.A., da Fonseca, E.B. and Hod, M., “The first-trimester of pregnancy - A window of opportunity for prediction and prevention of pregnancy complications and future life”, Diabetes Research and Clinical Practice, 145. 20-30. 2018.