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.
10 affiliations
- 1Intensive Care and Obstetric Research Group (GRICIO), Department of Obstetrics and Gynaecology, Faculty of Medicine, Universidad de Cartagena, Cartagena, Colombia.
- 2GINUMED Research Group, Corporación Universitaria Rafael Núñez, Cartagena, Colombia.
- 3ESE Hospital San José de Maicao, Maicao, La Guajira, Colombia.
- 4ALZAK Foundation, Cartagena de Indias, Bolívar, Colombia.
- 5ESE Hospital La Divina Misericordia, Magangué, Bolívar, Colombia.
- 6Clínica CEDES, Riohacha, La Guajira, Colombia.
- 7INCINTA Consultores S.A.S., Cali, Colombia.
- 8Postgrado de Medicina Crítica, Universidad del Sinú, Cartagena, Colombia.
- 9Universidad CES, Medellin, Colombia.
- 10Secretaria Distrital de Salud de Cartagena, Bolívar, Colombia.
Abstract
Background: Obstetric high-dependency units may improve rescue care when embedded within broader maternal safety strategies. Objective: To evaluate a multi-component maternal safety and technological strengthening model, including obstetric high-dependency capacity, across three Colombian Caribbean institutions with different governance models. Methods: We conducted a multisite before-and-after implementation evaluation within a Ministry-funded maternal safety project. The model was implemented in one private clinic and two public hospitals in La Guajira and Bolívar, 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-period variation from 2018 to 2023 was treated descriptively. Interrupted time series analyses were performed where post-implementation data allowed. Findings: Implementation was associated with heterogeneous but generally favourable patterns. At Clínica CEDES, costs increased after implementation, while intensive care utilisation and several severe maternal morbidity indicators declined. At ESE Hospital San José de Maicao, mature post-implementation economic and conventional pre/post-clinical comparisons were unavailable; however, interrupted time series analyses showed favourable changes in longitudinal quality indicators, including reductions in weighted adverse outcome score (WAOS) level (β = -8.30, P = 0.0016) and slope (β = -1.20, P = 0.0064), adverse outcome index (AOI) level (β = -1.13, P = 0.0032), and severity index (SI) slope (β = -0.27, P = 0.030). ESE Hospital La Divina Misericordia showed mixed early clinical signals and descriptive quality improvement, but follow-up was limited. Conclusions: A multi-component maternal safety model including obstetric high-dependency capacity may improve maternal care in high-risk settings, although effects vary by institutional context. High-dependency units appear most effective as part of an integrated rescue system rather than isolated infrastructure.
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BibTeX
@article{rojassuarez2026costutility,
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.}},
author = {José Rojas-Suárez and Cintia Durán and Nestor Lora and Laura Briñez and Abril Calderón and Walter Annicchiarico-López and Nelson Alvis-Zakzuk and Larry Laza and Andrea Peña and Juan Carlos Correa and Mauricio Vasco-Ramirez and María Escobar-Vidarte and Javier Carvajal and Jairo Guerrero and Carmelo Dueñas-Castell and Rafael Navarro-España and José Santacruz-Arias},
journal = {Annals of global health},
year = {2026},
month = oct,
doi = {10.5334/aogh.5403},
url = {https://europepmc.org/article/MED/42909174},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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.
AU - José Rojas-Suárez
AU - Cintia Durán
AU - Nestor Lora
AU - Laura Briñez
AU - Abril Calderón
AU - Walter Annicchiarico-López
AU - Nelson Alvis-Zakzuk
AU - Larry Laza
AU - Andrea Peña
AU - Juan Carlos Correa
AU - Mauricio Vasco-Ramirez
AU - María Escobar-Vidarte
AU - Javier Carvajal
AU - Jairo Guerrero
AU - Carmelo Dueñas-Castell
AU - Rafael Navarro-España
AU - José Santacruz-Arias
PY - 2026
DA - 2026/10/16
JO - Annals of global health
DO - 10.5334/aogh.5403
UR - https://europepmc.org/article/MED/42909174
AB - Background: Obstetric high-dependency units may improve rescue care when embedded within broader maternal safety strategies. Objective: To evaluate a multi-component maternal safety and technological strengthening model, including obstetric high-dependency capacity, across three Colombian Caribbean institutions with different governance models. Methods: We conducted a multisite before-and-after implementation evaluation within a Ministry-funded maternal safety project. The model was implemented in one private clinic and two public hospitals in La Guajira and Bolívar, 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-period variation from 2018 to 2023 was treated descriptively. Interrupted time series analyses were performed where post-implementation data allowed. Findings: Implementation was associated with heterogeneous but generally favourable patterns. At Clínica CEDES, costs increased after implementation, while intensive care utilisation and several severe maternal morbidity indicators declined. At ESE Hospital San José de Maicao, mature post-implementation economic and conventional pre/post-clinical comparisons were unavailable; however, interrupted time series analyses showed favourable changes in longitudinal quality indicators, including reductions in weighted adverse outcome score (WAOS) level (β = -8.30, P = 0.0016) and slope (β = -1.20, P = 0.0064), adverse outcome index (AOI) level (β = -1.13, P = 0.0032), and severity index (SI) slope (β = -0.27, P = 0.030). ESE Hospital La Divina Misericordia showed mixed early clinical signals and descriptive quality improvement, but follow-up was limited. Conclusions: A multi-component maternal safety model including obstetric high-dependency capacity may improve maternal care in high-risk settings, although effects vary by institutional context. High-dependency units appear most effective as part of an integrated rescue system rather than isolated infrastructure.
SN - 2214-9996
ER -