A quality of health outcomes model for guiding obstetrical practice

Purpose: To describe the application of the Quality of Health Outcomes Mode l, introduced by the American Academy of Nursing Expert Panel on Quality of Health Care, to obstetrical care, particularly second-stage labor. Organizing Framework: The model is different from the more linear structure -process-outcome frameworks used in the past to a dynamic conceptualization of reciprocal relationships among the system, intervention, client, and ou tcome components. Analysis of these components can provide a comprehensive picture of the complexity of patient care decision making in hospital labor and delivery units. Conclusions: Research findings indicate that interventions such as cesarean delivery and epidural analgesia may result in several significant quality of health outcomes for women that should receive increased attention. Uses of this model for shaping best practices among physicians and nurses and fo r setting directions for priorities in future interdisciplinary research an d health policy are discussed.