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.

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.