{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T07:49:50Z","timestamp":1792136990228,"version":"4.4.0"},"reference-count":28,"publisher":"Ubiquity Press, Ltd.","issue":"1","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100022965","name":"Ministerio de Ciencia, Tecnolog\u00eda e Innovaci\u00f3n","doi-asserted-by":"publisher","award":["92092"],"award-info":[{"award-number":["92092"]}],"id":[{"id":"10.13039\/100022965","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["89"],"abstract":"<jats:p>Background: Obstetric high\u2011dependency units may improve rescue care when embedded within broader maternal safety strategies.\nObjective: To evaluate a multi\u2011component maternal safety and technological strengthening model, including obstetric high\u2011dependency capacity, across three Colombian Caribbean institutions with different governance models.\nMethods: We conducted a multisite before\u2011and\u2011after implementation evaluation within a Ministry\u2011funded maternal safety project. The model was implemented in one private clinic and two public hospitals in La Guajira and Bol\u00edvar, Colombia, with staggered implementation and varying data maturity. Data sources included billing records, administrative databases, and monthly quality indicators. Costs, severe maternal morbidity indicators, and longitudinal quality metrics were analysed by institutional implementation window. Pandemic\u2011period variation from 2018 to 2023 was treated descriptively. Interrupted time series analyses were performed where post\u2011implementation data allowed.\nFindings: Implementation was associated with heterogeneous but generally favourable patterns. At Cl\u00ednica CEDES, costs increased after implementation, while intensive care utilisation and several severe maternal morbidity indicators declined. At ESE Hospital San Jos\u00e9 de Maicao, mature post\u2011implementation economic and conventional pre\/post\u2011clinical comparisons were unavailable; however, interrupted time series analyses showed favourable changes in longitudinal quality indicators, including reductions in weighted adverse outcome score (WAOS) level (\u03b2 = \u22128.30, P = 0.0016) and slope (\u03b2 = \u22121.20, P = 0.0064), adverse outcome index (AOI) level (\u03b2 = \u22121.13, P = 0.0032), and severity index (SI) slope (\u03b2 = \u22120.27, P = 0.030). ESE Hospital La Divina Misericordia showed mixed early clinical signals and descriptive quality improvement, but follow\u2011up was limited.\nConclusions: A multi\u2011component maternal safety model including obstetric high\u2011dependency capacity may improve maternal care in high\u2011risk settings, although effects vary by institutional context. High\u2011dependency units appear most effective as part of an integrated rescue system rather than isolated infrastructure.<\/jats:p>","DOI":"10.5334\/aogh.5403","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T07:26:31Z","timestamp":1792135591000},"page":"102","source":"Crossref","is-referenced-by-count":0,"title":["Cost-Utility and Clinical Impact of a Multicomponent Maternal Safety and High-Dependency Care Model in Three Colombian Caribbean Hospitals: A Before-and-After Study"],"prefix":"10.5334","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0310-3235","authenticated-orcid":false,"given":"Jos\u00e9","family":"Rojas-Su\u00e1rez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cintia","family":"Dur\u00e1n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nestor","family":"Lora","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Bri\u00f1ez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abril","family":"Calder\u00f3n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Annicchiarico-L\u00f3pez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson","family":"Alvis-Zakzuk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry","family":"Laza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Pe\u00f1a","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Carlos","family":"Correa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauricio","family":"Vasco-Ramirez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Escobar-Vidarte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Carvajal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jairo","family":"Guerrero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmelo","family":"Due\u00f1as-Castell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Navarro-Espa\u00f1a","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Santacruz-Arias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3285","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"key":"1","unstructured":"World Health Organization. Trends in maternal mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, World Bank group and UNDESA\/Population division. Published 2023. https:\/\/www.who.int\/publications\/i\/item\/9789240068759."},{"key":"2","doi-asserted-by":"crossref","unstructured":"Geller SE, Koch AR, Garland CE, MacDonald EJ, Storey F, Lawton B. A global view of severe maternal morbidity: Moving beyond maternal mortality. Reprod Health. 2018;15(Suppl 1):98. doi:10.1186\/s12978-018-0527-2.","DOI":"10.1186\/s12978-018-0527-2"},{"key":"3","doi-asserted-by":"crossref","unstructured":"Pinilla Saraza ME. Mortalidad materna en Colombia, 2019. Reporte Epidemiol\u00f3gico Nacional. 2021;2(3):27\u201342. doi:10.33610\/01229907.2020v2n3a3.","DOI":"10.33610\/01229907.2020v2n3a3"},{"key":"4","unstructured":"Weekly Epidemiological Report. Morbilidad materna extrema. Instituto Nacional de Salud. May, 2021;20:1\u20138. https:\/\/www.ins.gov.co\/BibliotecaDigital\/2021-boletin-epidemiologico-semana-20.pdf."},{"key":"5","unstructured":"Arregoc\u00e9s SN, Molina RT. Inequalities and sociodemographic characteristics of maternal mortality in La Guajira, Colombia, 2010\u20132012. Rev Panam Salud Publica. 2015;37:239\u2013244. PubMed PMID: 26208191."},{"key":"6","doi-asserted-by":"crossref","unstructured":"Rojas\u2011Suarez J, Paruk F. Maternal high\u2011care and intensive care units in low\u2011 and middle\u2011income countries. Best Pract Res Clin Obstet Gynaecol. 2024;93:102474. doi:10.1016\/j.bpobgyn.2024.102474.","DOI":"10.1016\/j.bpobgyn.2024.102474"},{"key":"7","unstructured":"World Health Organization. Evaluating the Quality of Care for Severe Pregnancy Complications: The WHO Near\u2011Miss Approach for Maternal Health. World Health Organization; 2011:29. https:\/\/www.who.int\/publications\/i\/item\/9789241502221."},{"key":"8","doi-asserted-by":"crossref","unstructured":"Colombia, Instituto Nacional de Salud. Protocolo de Vigilancia en Salud P\u00fablica de Morbilidad materna extrema. Published 2024. https:\/\/www.ins.gov.co\/buscador-eventos\/Lineamientos\/Pro_MME%202024.pdf [Version 6].","DOI":"10.33610\/407561qbqrpe"},{"key":"9","doi-asserted-by":"crossref","unstructured":"Kern\u2011Goldberger AR, Howell EA, Srinivas SK, Levine LD. What we talk about when we talk about severe maternal morbidity: A call to action to critically review severe maternal morbidity as an outcome measure. Am J Obstet Gynecol MFM. 2023;5(5):100882. doi:10.1016\/j.ajogmf.2023.100882.","DOI":"10.1016\/j.ajogmf.2023.100882"},{"key":"10","doi-asserted-by":"crossref","unstructured":"Mann S, Pratt S, Gluck P, et al. Assessing Quality in Obstetrical Care: Development of Standardized Measures. Jt Comm J Qual Patient Saf. 2006;32(9):497\u2013505. doi:10.1016\/S1553-7250(06)32065-X.","DOI":"10.1016\/S1553-7250(06)32065-X"},{"key":"11","doi-asserted-by":"crossref","unstructured":"Ryan M, Hamilton V, Bowen M, McKenna P. The role of a high\u2010dependency unit in a regional obstetric hospital. Anaesthesia. 2000;55(12):1155\u20131158. doi:10.1046\/j.1365-2044.2000.01627.x.","DOI":"10.1046\/j.1365-2044.2000.01627.x"},{"key":"12","doi-asserted-by":"crossref","unstructured":"Amiruddin N, Prescott GJ, Coventry DA, Jansen JO. Evaluating service development in critical care: The impact of establishing a medical high dependency unit on intensive care unit workload, case mix, and mortality. J Intensive Care Soc. 2018;19(3):226\u2013235. doi:10.1177\/1751143718755014.","DOI":"10.1177\/1751143718755014"},{"key":"13","doi-asserted-by":"crossref","unstructured":"Lissauer D, Gadama L, Waitt C, et al. A Multicomponent Intervention to Improve Maternal Infection Outcomes. 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