1
|
Neppelenbroek E, Jornada Ben Â, Nij Bijvank BSWA, Bosmans JE, Groenen CJM, Jonge AD, Verhoeven CJM. Antenatal cardiotocography in primary midwife-led care: a budget impact analysis. BMJ Open Qual 2024; 13:e002578. [PMID: 38839395 PMCID: PMC11163679 DOI: 10.1136/bmjoq-2023-002578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 05/28/2024] [Indexed: 06/07/2024] Open
Abstract
OBJECTIVES In many countries, the healthcare sector is dealing with important challenges such as increased demand for healthcare services, capacity problems in hospitals and rising healthcare costs. Therefore, one of the aims of the Dutch government is to move care from in-hospital to out-of-hospital care settings. An example of an innovation where care is moved from a more specialised setting to a less specialised setting is the performance of an antenatal cardiotocography (aCTG) in primary midwife-led care. The aim of this study was to assess the budget impact of implementing aCTG for healthy pregnant women in midwife-led care compared with usual obstetrician-led care in the Netherlands. METHODS A budget impact analysis was conducted to estimate the actual costs and reimbursement of aCTG performed in midwife-led care and obstetrician-led care (ie, base-case analysis) from the Dutch healthcare perspective. Epidemiological and healthcare utilisation data describing both care pathways were obtained from a prospective cohort, survey and national databases. Different implementation rates of aCTG in midwife-led care were explored. A probabilistic sensitivity analysis was conducted to estimate the uncertainty surrounding the budget impact estimates. RESULTS Shifting aCTG from obstetrician-led care to midwife-led-care would increase actual costs with €311 763 (97.5% CI €188 574 to €426 072) and €1 247 052 (97.5% CI €754 296 to €1 704 290) for implementation rates of 25% and 100%, respectively, while it would decrease reimbursement with -€7 538 335 (97.5% CI -€10 302 306 to -€4 559 661) and -€30 153 342 (97.5% CI -€41 209 225 to -€18 238 645) for implementation rates of 25% and 100%, respectively. The sensitivity analysis results were consistent with those of the main analysis. CONCLUSIONS From the Dutch healthcare perspective, we estimated that implementing aCTG in midwife-led care may increase the associated actual costs. At the same time, it might lower the healthcare reimbursement.
Collapse
Affiliation(s)
- Elise Neppelenbroek
- Amsterdam UMC location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
| | - Ângela Jornada Ben
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Bas S W A Nij Bijvank
- Department of Obstetrics and Gynecology, Isala Women and Children's Hospital, Zwolle, Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Carola J M Groenen
- Amalia Children's Hospital, Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Ank de Jonge
- Amsterdam UMC location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
| | - Corine J M Verhoeven
- Amsterdam UMC location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, Netherlands
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, UK
| |
Collapse
|
2
|
Neppelenbroek EM, van der Heijden OWH, de Vet HCW, de Groot AJJ, Daemers DOA, de Jonge A, Verhoeven CJM. Inter- and intraobserver agreement of antenatal cardiotocography assessments by maternity care professionals: A prospective study. Int J Gynaecol Obstet 2024. [PMID: 38516915 DOI: 10.1002/ijgo.15497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 03/03/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE In the Netherlands, antenatal cardiotocography (aCTG) to assess fetal well-being is performed in obstetrician-led care. An innovative initiative was started to evaluate whether aCTG for specific indications-reduced fetal movements, external cephalic version, or postdate pregnancy-is feasible in non-obstetrician-led care settings by independent primary care midwives. Quality assessment is essential when reorganizing and shifting tasks and responsibilities. Therefore, we aimed to assess the inter- and intraobserver agreement for aCTG assessments between and within four professional groups involved in Dutch maternity care regarding the overall classification and assessment of the various components of aCTG. METHOD This was a prospective study among 47 Dutch primary care midwives, hospital-based midwives, residents, and obstetricians. Ten aCTG traces were assessed twice at a 1 month interval. To ensure a representative sample, we used two different sets of 10 aCTG traces each. We calculated the degree of agreement using the proportions of agreement. RESULTS The proportions of agreement for interobserver agreement on the classification of aCTG between and within the four professional groups varied from 0.82 to 0.94. The proportions of agreement for each professional group were slightly higher for intraobserver (0.86-0.94) than for interobserver agreement. For the various aCTG components, the proportions of agreement for interobserver agreement varied from 0.64 (presence of contractions) to 0.98 (baseline heart frequency). CONCLUSION The proportion of agreement levels between and within the maternity care professionals in the classification of aCTG traces among healthy women were comparable. This means that these professional groups are equally well able to classify aCTGs in healthy pregnant women.
Collapse
Affiliation(s)
- Elise M Neppelenbroek
- Midwifery Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Olivier W H van der Heijden
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, Netherlands
| | - Henrica C W de Vet
- Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Amanda J J de Groot
- Department of Obstetrics and Gynecology, University Medical Center Rotterdam, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
| | - Darie O A Daemers
- Research Center for Midwifery Practice, Zuyd University of Applied Sciences, Maastricht, Netherlands
| | - Ank de Jonge
- Midwifery Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Amsterdam Reproduction and Development, Amsterdam, Netherlands
| | - Corine J M Verhoeven
- Midwifery Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, UK
- Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, Netherlands
| |
Collapse
|
3
|
Roe Y, Allen J, Haora P, Hickey S, Briggs M, Wilkes L, Nelson C, Watego K, Coddington R, Ireland S, Kruske S, Gao Y, Kildea S. Enabling the context for Aboriginal and Torres Strait Islander Community Controlled Birthing on Country services: Participatory action research. Women Birth 2024; 37:368-378. [PMID: 38097448 DOI: 10.1016/j.wombi.2023.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/24/2023] [Accepted: 11/24/2023] [Indexed: 03/05/2024]
Abstract
PROBLEM Establishment of Birthing on Country services owned and governed by Aboriginal and Torres Strait Islander Community Controlled Health Services has been slow. BACKGROUND Birthing on Country services have demonstrated health and cost benefits and require redesign of maternity care. During the Building On Our Strengths feasibility study, use of endorsed midwives and licensing of birth centres has proven difficult. QUESTION What prevents Community Controlled Health Services from implementing Birthing on Country services in Queensland and New South Wales? METHODS Participatory action research identified implementation barriers. We conducted iterative document analysis of instruments to inform government lobbying through synthesis of policy, economic, social, technological, legal, and environmental factors. FINDINGS Through cycles of participatory action research, we analysed 17 documents: 1) policy barriers prevent Community Controlled Health Services from employing endorsed midwives to provide intrapartum care in public hospitals; 2) economic barriers include lack of sustainable funding stream and inadequate Medicare-billing for endorsed midwives; and 3) legal barriers require a medical practitioner in a birth centre. While social barriers (e.g., colonisation, medicalisation) underpin regulations, these were beyond the scope; technological and environmental barriers were not identified. DISCUSSION Findings are consistent with the literature on barriers to midwifery practice. Recommendations include a national audit of barriers to Birthing on Country services including healthcare practice insurance, and development of a funding stream. Additionally, private maternity facility regulation must align with evidence on safe birth centre operation. CONCLUSION Government can address barriers to scale-up of Aboriginal and Torres Strait Islander Community Controlled Birthing on Country services.
Collapse
Affiliation(s)
- Yvette Roe
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
| | - Jyai Allen
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia.
| | - Penny Haora
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
| | - Sophie Hickey
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
| | - Melanie Briggs
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia; Waminda South Coast Women's Health and Welfare Aboriginal Corporation, Nowra, Australia
| | - Liz Wilkes
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia; My Midwives, Brisbane, Australia
| | - Carmel Nelson
- Institute for Urban Indigenous Health, Brisbane, Australia
| | - Kristie Watego
- Institute for Urban Indigenous Health, Brisbane, Australia
| | - Rebecca Coddington
- Waminda South Coast Women's Health and Welfare Aboriginal Corporation, Nowra, Australia
| | - Sarah Ireland
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
| | - Sue Kruske
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
| | - Yu Gao
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
| | - Sue Kildea
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
| |
Collapse
|
4
|
Neppelenbroek EM, Verhoeven CJM, van der Heijden OWH, van der Pijl MSG, Groenen CJM, Ganzevoort W, Bijvank BSWAN, de Jonge A. Antenatal cardiotocography in dutch primary midwife-led care: Maternal and perinatal outcomes and serious adverse events. A prospective observational cohort study. Women Birth 2024; 37:177-187. [PMID: 37648620 DOI: 10.1016/j.wombi.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/27/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
PROBLEM It is yet unknown whether shifting antenatal cardiotocography (aCTG) from obstetrician-led to midwife-led care leads to a safe reduction in referrals. BACKGROUND ACTG is used to assess fetal well-being. In the Netherlands, the procedure has until now been performed as part of obstetrician-led care. Developments in E-health facilitates the performance of aCTG outside the hospital in midwife-led care, hereby increasing continuity of care. AIM To evaluate 1) process outcomes of implementing aCTG for specific indications in primary midwife-led care; 2) maternal and perinatal outcomes of pregnant women receiving aCTG in midwife-led care; 3) serious adverse events (with outcomes, causes, avoidability, and potential prevention strategies) that have occurred during the innovation project 'aCTG in midwife-led care'. METHODS Prospective observational cohort study and a case series study of serious adverse events. FINDINGS A total of 1584 pregnant women with a specific aCTG indication were included in this cohort study for whom 1795 aCTGs were performed in midwife-led care. 1591 aCTGs(89.7%) were classified as reassuring. Referral to obstetrician-led care occurred for 234 women(13.0%) after an aCTG in midwife-led care of whom 202(86%) were referred back. Severe neonatal morbidity occurred in 27 neonates (1.7%). In the 5736 aCTGs included in the case series study, one case with a serious neonatal outcome was assessed as a serious adverse event attributable to human factors. DISCUSSION ACTGs performed in midwife-led care increased continuity of care. In this innovation project, maternal and perinatal outcomes were in the expected range for women in midwife-led care.
Collapse
Affiliation(s)
- Elise M Neppelenbroek
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands; Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, Groningen, Netherlands.
| | - Corine J M Verhoeven
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands; Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, Groningen, Netherlands; University of Nottingham, Department of Midwifery, School of Health Sciences, Nottingham, United Kingdom; Maxima Medical Centre, Department of Obstetrics and Gynaecology, Veldhoven, Netherlands
| | - Olivier W H van der Heijden
- Amalia Children's Hospital, Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Marit S G van der Pijl
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands; Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, Groningen, Netherlands
| | - Carola J M Groenen
- Amalia Children's Hospital, Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Wessel Ganzevoort
- Amsterdam University Medical Centres, Universiteit van Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Bas S W A Nij Bijvank
- Department of Obstetrics and Gynecology, Isala Women and Children's hospital, Zwolle, Netherlands
| | - Ank de Jonge
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, Groningen, Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| |
Collapse
|
5
|
Liebregts J, Goodarzi B, Valentijn PP, Downe S, Erwich JJ, Burchell G, Batenburg R, de Vries EF, de Jonge A, Verhoeven CJM. Elements of organisation of integrated maternity care and their associations with outcomes: a scoping review protocol. BMJ Open 2024; 14:e075344. [PMID: 38176859 PMCID: PMC10773375 DOI: 10.1136/bmjopen-2023-075344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION Integrated care is seen as an enabling strategy in organising healthcare to improve quality, finances, personnel and sustainability. Developments in the organisation of maternity care follow this trend. The way care is organised should support the general aims and outcomes of healthcare systems. Organisation itself consists of a variety of smaller 'elements of organisation'. Various elements of organisation are implemented in different organisations and networks. We will examine which elements of integrated maternity care are associated with maternal and neonatal health outcomes, experiences of women and professionals, healthcare spending and care processes. METHODS AND ANALYSIS We will conduct this review using the JBI methodology for scoping reviews and the reporting guideline PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews). We will undertake a systematic search in the databases PubMed, Scopus, Cochrane and PsycINFO. A machine learning tool, ASReview, will be used to select relevant papers. These papers will be analysed and classified thematically using the framework of the Rainbow Model of Integrated Care (RMIC). The Population Concept Context framework for scoping reviews will be used in which 'Population' is defined as elements of the organisation of integrated maternity care, 'Context' as high-income countries and 'Concepts' as outcomes stated in the objective of this review. We will include papers from 2012 onwards, in Dutch or English language, which describe both 'how the care is organised' (elements) and 'outcomes'. ETHICS AND DISSEMINATION Since this is a scoping review of previously published summary data, ethical approval for this study is not needed. Findings will be published in a peer-reviewed international journal, discussed in a webinar and presented at (inter)national conferences and meetings of professional associations.The findings of this scoping review will give insight into the nature and effectiveness of elements of integrated care and will generate hypotheses for further research.
Collapse
Affiliation(s)
- Jolanda Liebregts
- Midwifery Science, Amsterdam UMC Locatie VUMC, Amsterdam, Netherlands
| | - Bahareh Goodarzi
- Midwifery Science, Amsterdam UMC Locatie VUMC, Amsterdam, Netherlands
| | - Pim P Valentijn
- Department of Health Services Research, Maastricht University, Maastricht, Netherlands
| | - Soo Downe
- Research in Childbirth and Health, University of Central Lancashire, Lancashire, UK
| | - Jan Jaap Erwich
- Obstetrics and Gynaecology, University of Groningen, Groningen, Netherlands
| | - George Burchell
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ronald Batenburg
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Eline F de Vries
- Department of Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, Bilthoven, Netherlands
- Leiden University Campus The Hague, National Institute of Public Health and Primary Care, The Hague, Netherlands
| | - Ank de Jonge
- Midwifery Science, AVAG, APH Research Institute, Amsterdam UMC Locatie VUMC, Amsterdam, Netherlands
| | - Corine J M Verhoeven
- Midwifery Science, Amsterdam UMC Locatie VUMC, Amsterdam, Netherlands
- Midwifery, School of Health Sciences, University of Nottingham, Nottingham, UK
| |
Collapse
|
6
|
Neppelenbroek EM, Ammerlaan AJM, van der Heijden OWH, van der Pijl MSG, Kaiser A, de Jonge A, Verhoeven CJM. Antenatal cardiotocography in primary midwife-led care: Women's satisfaction. Birth 2023; 50:798-807. [PMID: 37261779 DOI: 10.1111/birt.12725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/24/2023] [Accepted: 04/27/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND In the Netherlands, antenatal cardiotocography (aCTG), used to assess fetal well-being, is performed in obstetrician-led care. To improve continuity of care, an innovation project was designed wherein primary care midwives perform aCTGs for specific indications. The aim of this study was to examine the satisfaction and experiences of pregnant women who received an aCTG in primary midwife-led care and explore which factors were associated with high satisfaction. METHODS Data were collected through a self-administered questionnaire based on the Consumer Quality Index. The primary outcome was general satisfaction on a 10-point scale, with a score above nine indicating participants were "highly satisfied". RESULTS In total, 1227 women were included in the analysis. The study showed a mean general satisfaction score of 9.2. Most women were highly satisfied with receiving an aCTG in primary midwife-led care (77.4%). On the Consumer Quality Index, the mean satisfaction level varied from 3.98 (SD ± 0.11) for the subscale "client satisfaction" to 3.87 (SD ± 0.32) for the subscale "information provision" on a 4-point scale. Women at between 33 and 36 weeks' gestation were more likely to be highly satisfied (adjusted OR [aOR] = 3.35). Compared with a completely comfortable position during the aCTG, a mostly comfortable or somewhat comfortable level had decreased odds of being associated with a ranking of highly satisfied (aOR 0.24 and 0.19, respectively). CONCLUSIONS This study shows that pregnant women are satisfied with having an aCTG in midwife-led care. Providing aCTG in midwife-led care can increase access to continuity of care.
Collapse
Affiliation(s)
- Elise M Neppelenbroek
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anouk J M Ammerlaan
- Verloskundigen Buitenwatersloot (Midwifery Practice), Delft, The Netherlands
| | - Olivier W H van der Heijden
- Department of Obstetrics and Gynaecology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marit S G van der Pijl
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anouk Kaiser
- Het Buikencollectief, Heemstede, The Netherlands
| | - Ank de Jonge
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Corine J M Verhoeven
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, The Netherlands
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, UK
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, The Netherlands
| |
Collapse
|
7
|
Battershell M, Vu H, Callander EJ, Slavin V, Carrandi A, Teede H, Bull C. Development, women-centricity and psychometric properties of maternity patient-reported outcome measures (PROMs): A systematic review. Women Birth 2023; 36:e563-e573. [PMID: 37316400 DOI: 10.1016/j.wombi.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/04/2023] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Measuring maternity care outcomes based on what women value is critical to promoting woman-centred maternity care. Patient-reported outcome measures (PROMs) are instruments that enable service users to assess healthcare service and system performance. AIM To identify and critically appraise the risk of bias, woman-centricity (content validity) and psychometric properties of maternity PROMs published in the scientific literature. METHODS MEDLINE, CINAHL Plus, PsycINFO and Embase were systematically searched for relevant records between 01/01/2010 and 07/10/2021. Included articles underwent risk of bias, content validity and psychometric properties assessments in line with COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance. PROM results were summarised according to language subgroups and an overall recommendation for use was determined. FINDINGS Forty-four studies reported on the development and psychometric evaluation of 9 maternity PROMs, grouped into 32 language subgroups. Risk of bias assessments for the PROM development and content validity showed inadequate or doubtful methodological quality. Internal consistency reliability, hypothesis testing (for construct validity), structural validity and test-retest reliability varied markedly in sufficiency and evidence quality. No PROMs received a level 'A' recommendation, required for real-world use. CONCLUSION Maternity PROMs identified in this systematic review had poor quality evidence for their measurement properties and lacked sufficient content validity, indicating a lack of woman-centricity in instrument development. Future research should prioritise women's voices in deciding what is relevant, comprehensive and comprehensible to measure, as this will impact overall validity and reliability and facilitate real-world use.
Collapse
Affiliation(s)
- M Battershell
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, VIC, Australia
| | - H Vu
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, VIC, Australia
| | - E J Callander
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, VIC, Australia
| | - V Slavin
- Women-Newborn-Childrens Services, Gold Coast Health, QLD, Australia; School of Nursing and Midwifery, Griffith University, Meadowbrook, QLD, Australia
| | - A Carrandi
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, VIC, Australia
| | - H Teede
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, VIC, Australia; Endocrinology and Diabetes Units, Monash Health, VIC, Australia
| | - C Bull
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, VIC, Australia.
| |
Collapse
|
8
|
van den Berg LMM, Balaam MC, Nowland R, Moncrieff G, Topalidou A, Thompson S, Thomson G, de Jonge A, Downe S, Ellison G, Fenton A, Heazell A, de Jonge A, Kingdon C, Matthews Z, Severns A, Thomson G, Topalidou A, Wright A, Akooji N, Balaam MC, Cull J, van den Berg L, Crossland N, Feeley C, Franso B, Heys S, Moncrief G, Nowland R, Sarian A, Booker M, Sandall J, Thornton J, Lynskey-Wilkie T, Wilson V, Abe R, Awe T, Adeyinka T, Bender-Atik R, Brigante L, Brione R, Cadée F, Duff E, Draycott T, Fisher D, Francis A, Franx A, Erasmus M, Frith L, Griew L, Harmer C, Homer C, Knight M, Mansfield A, Marlow N, Mcaree T, Monteith D, Reed K, Richens Y, Rocca-Ihenacho L, Ross-Davie M, Talbot S, Taylor M, Treadwell M. The United Kingdom and the Netherlands maternity care responses to COVID-19: A comparative study. Women Birth 2023; 36:127-135. [PMID: 35422406 PMCID: PMC8979792 DOI: 10.1016/j.wombi.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/17/2022] [Accepted: 03/31/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The national health care response to coronavirus (COVID-19) has varied between countries. The United Kingdom (UK) and the Netherlands (NL) have comparable maternity and neonatal care systems, and experienced similar numbers of COVID-19 infections, but had different organisational responses to the pandemic. Understanding why and how similarities and differences occurred in these two contexts could inform optimal care in normal circumstances, and during future crises. AIM To compare the UK and Dutch COVID-19 maternity and neonatal care responses in three key domains: choice of birthplace, companionship, and families in vulnerable situations. METHOD A multi-method study, including documentary analysis of national organisation policy and guidance on COVID-19, and interviews with national and regional stakeholders. FINDINGS Both countries had an infection control focus, with less emphasis on the impact of restrictions, especially for families in vulnerable situations. Differences included care providers' fear of contracting COVID-19; the extent to which community- and personalised care was embedded in the care system before the pandemic; and how far multidisciplinary collaboration and service-user involvement were prioritised. CONCLUSION We recommend that countries should 1) make a systematic plan for crisis decision-making before a serious event occurs, and that this must include authentic service-user involvement, multidisciplinary collaboration, and protection of staff wellbeing 2) integrate women's and families' values into the maternity and neonatal care system, ensuring equitable inclusion of the most vulnerable and 3) strengthen community provision to ensure system wide resilience to future shocks from pandemics, or other unexpected large-scale events.
Collapse
Affiliation(s)
- Lauri M M van den Berg
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Public Health, The Netherlands.
| | - Marie-Clare Balaam
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Rebecca Nowland
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Gill Moncrieff
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Anastasia Topalidou
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Suzanne Thompson
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Public Health, The Netherlands; Research Centre of Midwifery Science Maastricht, Zuyd University, The Netherlands
| | - Gill Thomson
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | - Ank de Jonge
- Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Reproduction and Development, The Netherlands
| | - Soo Downe
- School of Community Health and Midwifery, Faculty of Health and Care, University of Central Lancashire, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Implementing midwifery continuity of care models in regional Australia: A constructivist grounded theory study. Women Birth 2023; 36:99-107. [PMID: 35410848 DOI: 10.1016/j.wombi.2022.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/03/2022] [Accepted: 03/16/2022] [Indexed: 01/25/2023]
Abstract
PROBLEM/BACKGROUND Strong international evidence demonstrates significantly improved outcomes for women and their babies when supported by midwifery continuity of care models. Despite this, widespread implementation has not been achieved, especially in regional settings. AIM To develop a theoretical understanding of the factors that facilitate or inhibit the implementation of midwifery continuity models within regional settings. METHODS A Constructivist Grounded Theory approach was used to collect and analyse data from 34 interviews with regional public hospital key informants. RESULTS Three concepts of theory emerged: 'engaging the gatekeepers', 'midwives lacking confidence' and 'women rallying together'. The concepts of theory and sub-categories generated a substantive theory: A partnership between midwives and women is required to build confidence and enable the promotion of current evidence; this is essential for engaging key hospital stakeholders to invest in the implementation of midwifery continuity of care models. DISCUSSION The findings from this research suggest that midwives and women can significantly influence the implementation of midwifery continuity models within their local maternity services, particularly in regional settings. Midwives' reluctance to transition is based on a lack of confidence and knowledge of what it is really like to work in midwifery continuity models. Similarly, women require education to increase awareness of continuity of care benefits, and a partnership between women and midwives can be a strong political force to overcome many of the barriers. CONCLUSION Implementation of midwifery continuity of care needs a coordinated ground up approach in which midwives partner with women and promote widespread dissemination of evidence for this model, directed towards consumers, midwives, and hospital management to increase awareness of the benefits.
Collapse
|
10
|
Goodarzi B, Seijmonsbergen‐Schermers A, van Rijn M, Shah N, Franx A, de Jonge A. Maternal characteristics as indications for routine induction of labor: A nationwide retrospective cohort study. Birth 2022; 49:569-581. [PMID: 35229355 PMCID: PMC9546001 DOI: 10.1111/birt.12628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/17/2022] [Accepted: 02/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Maternal characteristics, such as parity and age, are increasingly considered indications for routine induction of labor of otherwise healthy women to prevent fetal and neonatal mortality. To fully balance the risks and benefits of induction of labor, we examined the association of additional relevant maternal characteristics and gestational age with fetal and neonatal mortality. METHODS We conducted a nationwide retrospective cohort study among a healthy Dutch population consisting of all singleton pregnancies in midwife-led care after 37 weeks of gestation in the period 2000-2018. We examined the association of maternal ethnicity, age, parity, and socioeconomic status with fetal and neonatal mortality, stratified by gestational age. The association of single characteristics was examined using descriptive statistics, and univariable and multivariable logistics regression analyses. The associations of multiple characteristics were examined using inter-categorical analyses and using interaction terms in the multivariable logistic regression analyses. RESULTS The results showed that ethnicity, age, parity, socioeconomic status, and gestational age did not act as single determinant of fetal and neonatal mortality. The probability of fetal and neonatal mortality differed among subgroups of women depending on which determinants were considered and the number of determinants included. CONCLUSIONS Decision-making about induction of labor to prevent fetal and neonatal mortality based on a single determinant may lead to overuse or underuse of IOL. A value-based health care strategy, addressing social inequity, and investing in better screening and diagnostic methods that employ an individualized and multi-determinant approach may be more effective at preventing fetal and neonatal mortality.
Collapse
Affiliation(s)
- Bahareh Goodarzi
- Department of Midwifery ScienceAmsterdam Public HealthAmsterdam UMCVrije Universiteit AmsterdamAVAGAmsterdamthe Netherlands
| | - Anna Seijmonsbergen‐Schermers
- Department of Midwifery ScienceAmsterdam Public HealthAmsterdam UMCVrije Universiteit AmsterdamAVAGAmsterdamthe Netherlands
| | - Maaike van Rijn
- Department of Obstetrics and GynaecologyHaga ZiekenhuisThe HagueThe Netherlands
| | - Neel Shah
- Department of Obstetrics, Gynaecology and Reproductive BiologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Arie Franx
- Department of Obstetrics and GynaecologyErasmus MCRotterdamthe Netherlands
| | - Ank de Jonge
- Department of Midwifery ScienceAmsterdam Reproduction and DevelopmentAmsterdam UMCVrije Universiteit AmsterdamAVAGAmsterdamthe Netherlands
| |
Collapse
|
11
|
Bull C, Teede H, Carrandi L, Rigney A, Cusack S, Callander E. Evaluating the development, woman-centricity and psychometric properties of maternity patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs): A systematic review protocol. BMJ Open 2022; 12:e058952. [PMID: 35144957 PMCID: PMC8845328 DOI: 10.1136/bmjopen-2021-058952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Woman-centred care is the right of every woman receiving maternity care, irrespective of where care is being received and who is providing care. This protocol describes a planned systematic review that will identify, describe and critically appraise the psychometric properties of maternity patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). The woman-centricity of PROM and PREM development and content validation (ie, the extent to which women were involved in these processes) will also be assessed. This information will be used to develop a maternity PROMs and PREMs database to support service and system performance measurement, and value-based maternity care initiatives. METHODS AND ANALYSIS This study will be guided by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline for systematic reviews of outcome measurement instruments. Studies identified via MEDLINE, CINAHL Plus, PsycINFO and EMBASE describing the development, content validation and/or psychometric evaluation of PROMs and PREMs specifically designed for maternity populations throughout pregnancy, childbirth and postnatal periods will be considered if published from 2010 onward, in English, and available in full text. The COSMIN risk of bias checklist will be used to evaluate the quality of studies reporting on the development, content validation and/or psychometric evaluation of PROMs and PREMs. COSMIN criteria for good content validity will be used to assess the woman-centricity of PROM and PREM development and content validation studies. COSMIN standards of good psychometric properties will be used to evaluate the validity and reliability of the identified instruments. ETHICS AND DISSEMINATION Ethical permission for this research is not required. The findings of this research will be submitted for publication in an international, peer-reviewed journal. Abstracts for national and international conference presentations will also be submitted. The proposed maternity PROMs and PREMs database will be freely accessible online, and developed with consumer input to ensure its usefulness to a range of maternity care stakeholders. PROSPERO REGISTRATION NUMBER CRD42021288854.
Collapse
Affiliation(s)
- Claudia Bull
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
- Monash Partners Academic Health Science Centre, Monash University, Clayton, Victoria, Australia
| | - Lane Carrandi
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Azure Rigney
- Maternity Choices Australia, Springwood, Queensland, Australia
| | - Sally Cusack
- Maternity Choices Australia, Springwood, Queensland, Australia
| | - Emily Callander
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
12
|
Models of Risk Selection in Maternal and Newborn Care: Exploring the Organization of Tasks and Responsibilities of Primary Care Midwives and Obstetricians in Risk Selection across The Netherlands. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031046. [PMID: 35162069 PMCID: PMC8834427 DOI: 10.3390/ijerph19031046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 02/01/2023]
Abstract
An effective system of risk selection is a global necessity to ensure women and children receive appropriate care at the right time and at the right place. To gain more insight into the existing models of risk selection (MRS), we explored the distribution of different MRS across regions in The Netherlands, and examined the relation between MRS and primary care midwives’ and obstetricians’ satisfaction with different MRS. We conducted a nationwide survey amongst all primary midwifery care practices and obstetrics departments. The questionnaire was completed by 312 (55%) primary midwifery care practices and 53 (72%) obstetrics departments. We identified three MRS, which were distributed differently across regions: (1) primary care midwives assess risk and initiate a consultation or transfer of care without discussing this first with the obstetrician, (2) primary care midwives assess risk and make decisions about consultation or transfer of care collaboratively with obstetricians, and (3) models with other characteristics. Across these MRS, variations exist in several aspects, including the routine involvement of the obstetrician in the care of healthy pregnant women. We found no significant difference between MRS and professionals’ level of satisfaction. An evidence- and value-based approach is recommended in the pursuit of the optimal organization of risk selection. This requires further research into associations between MRS and maternal and perinatal outcomes, professional payment methods, resource allocation, and the experiences of women and care professionals.
Collapse
|
13
|
van den Berg LMM, Gordon BBM, Kleefstra SM, Martijn L, van Dillen J, Verhoeven CJ, de Jonge A. Centralisation of acute obstetric care in the Netherlands: a qualitative study to explore the experiences of stakeholders with adaptations in organisation of care. BMC Health Serv Res 2021; 21:1233. [PMID: 34774037 PMCID: PMC8590329 DOI: 10.1186/s12913-021-07269-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/26/2021] [Indexed: 11/27/2022] Open
Abstract
Background In the past decade, acute obstetric care (AOC) has become centralised in many high-income countries. In this qualitative study, we explored how stakeholders in maternity care perceived and experienced adaptations in the organisation of maternity care in areas in the Netherlands where AOC was centralised. Methods A heterogenic group of fifteen maternity care stakeholders, including patients, were purposively selected for semi-structured interviews. An inductive thematic analysis was used. Results Three main themes were identified: (1) lack of involvement. (2) the process of making adaptations in the organisation of maternity care. (3) maintaining quality of care. Stakeholders in this study were highly motivated to maintain a high quality of maternity care and therefore made adaptations at several organisational levels. However, they felt a lack of involvement during the planning of centralisation of AOC and highlighted the importance of a collaborative process when making adaptations after centralisation of AOC. Conclusions Regions with AOC centralisation plans should invest time and money in change management, encourage early involvement of all maternity care stakeholders and acknowledge centralisation of AOC as a professional life event with associated emotions, including a feeling of unsafety. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07269-4.
Collapse
Affiliation(s)
- Lauri M M van den Berg
- Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.
| | - Bernardus Benjamin Maria Gordon
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6523 GA, Nijmegen, the Netherlands
| | - Sophia M Kleefstra
- Dutch Health and Youth Care Inspectorate, Stadsplateau 1, 3521 AZ, Utrecht, the Netherlands
| | - Lucie Martijn
- Dutch Health and Youth Care Inspectorate, Stadsplateau 1, 3521 AZ, Utrecht, the Netherlands
| | - Jeroen van Dillen
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6523 GA, Nijmegen, the Netherlands
| | - Corine J Verhoeven
- Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.,Maxima Medical Centre, Department of Obstetrics and Gynecology, De Run 4600, Veldhoven, Netherlands.,Division of Midwifery, School of Health Sciences, University of Nottingham, Floor 12, Tower Building, University Park, NG7 2RD, Nottingham, UK
| | - Ank de Jonge
- Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
| |
Collapse
|
14
|
Deichen Hansen ME. Predictors of preterm birth and low birth weight: A person-centered approach. SSM Popul Health 2021; 15:100897. [PMID: 34471667 PMCID: PMC8387774 DOI: 10.1016/j.ssmph.2021.100897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 08/14/2021] [Accepted: 08/15/2021] [Indexed: 12/19/2022] Open
Abstract
Objective Profound disparities exist among Black and White families who experience adverse infant health outcomes, yet much is unclear regarding factors that predict disparate outcomes. In order to address this gap, this study applied a person-centered, intersectional analysis to determine ways that women's typological risk profiles inform risk for preterm birth and low birth weight. Materials and methods In order to examine the role that social determinants play in predicting risk, this study implemented a latent class mixture modeling analysis of data from the Pregnancy Risk Assessment Monitoring System (PRAMS). Data were extracted from Pennsylvania and Illinois PRAMS surveys from 2012 to 2015 (n = 4336). Results Results of the study indicate three distinct risk types among women in the sample: low-, moderate- and high-risk. Three latent classes were identified: (1) low risk for PTB/LBW (44%); (2) moderate risk (19%); and (3) high risk (36%). Compared to class one, the likelihood of experiencing PTB were significantly higher for class three (x2PTB = 9.54, p < .001; x2LBW = 35.51, p < .001). The likelihood of experiencing LBW were significantly higher for class three, compared to class two (x2PTB = 9.21, p < .05; x2LBW = 21.17, p < .001).Within the three risk groups, racial disparities are particularly notable, with 76% of the sample's African American mothers falling into the “high-risk” category. Conclusion Public and perinatal health researchers, organizations, and funders are increasingly recognizing the need to identify methods that will best support health-promoting interventions that have the potential to close the racial disparity in PTB and LBW. Although racial disparities have long been noted, the findings from this study's analysis help to better understand how determinants of health intersect to create an overarching risk profile, which can be used to inform health interventions and services that may reduce the current Black-White gap in infant health outcomes. Profound race-based infant health disparities exist, yet much is unclear regarding factors that predict disparate outcomes. Disparities-related science has largely neglected theoretical models that could help conceptualize this complex issue. This article drew from a comprehensive theoretical framework to investigate disparities in infant health outcomes.
Collapse
Affiliation(s)
- Megan E Deichen Hansen
- Florida State University, College of Medicine, 1115 W Call St., Tallahassee, FL, 32304, USA
| |
Collapse
|
15
|
Dombrádi V, Bíró K, Jonitz G, Gray M, Jani A. Broadening the concept of patient safety culture through value-based healthcare. J Health Organ Manag 2021; ahead-of-print. [DOI: 10.1108/jhom-07-2020-0287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeDecision-makers are looking for innovative approaches to improve patient experience and outcomes with the finite resources available in healthcare. The concept of value-based healthcare has been proposed as one such approach. Since unsafe care hinders patient experience and contributes to waste, the purpose of this paper is to investigate how the value-based approach can help broaden the existing concept of patient safety culture and thus, improve patient safety and healthcare value.Design/methodology/approachIn the arguments, the authors use the triple value model which consists of personal, technical and allocative value. These three aspects together promote healthcare in which the experience of care is improved through the involvement of patients, while also considering the optimal utilisation and allocation of finite healthcare resources.FindingsWhile the idea that patient involvement should be integrated into patient safety culture has already been suggested, there is a lack of emphasis that economic considerations can play an important role as well. Patient safety should be perceived as an investment, thus, relevant questions need to be addressed such as how much resources should be invested into patient safety, how the finite resources should be allocated to maximise health benefits at a population level and how resources should be utilised to get the best cost-benefit ratio.Originality/valueThus far, both the importance of patient safety culture and value-based healthcare have been advocated; this paper emphasizes the need to consider these two approaches together.
Collapse
|
16
|
Villarmea S, Kelly B. Barriers to establishing shared decision-making in childbirth: Unveiling epistemic stereotypes about women in labour. J Eval Clin Pract 2020; 26:515-519. [PMID: 32227461 DOI: 10.1111/jep.13375] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 12/08/2019] [Accepted: 02/04/2020] [Indexed: 01/05/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The benefits for shared decision-making (SDM) in delivery of high-quality and personalized care are undisputed, but what is it about the dynamics of the delivery room that leads some to doubt that true SDM is possible? How difficult can it be to establish SDM as the norm when caring for a woman in labour? The discussion around SDM, autonomy, and rationality is timely and highly relevant to wider practice. METHOD The concept of a person's autonomy in decision-making about their body and health is generally accepted and is indeed enshrined in law in many countries. This ought to lay the foundation for SDM in obstetrics. Yet, women's experience speaks to an uncomfortable truth, namely, that it is far from commonplace. We are interested in exploring this tension between the law and the practice. RESULTS We examine a theory of female rationality and its application to women in labour, and juxtapose this with the view from the front line of care delivery. Is a woman in labour able to fully engage in an SDM process? In answering this question, associations in the discourses and practises around women's capacity during labour are revealed, which act as barriers, consciously or unconsciously, to establishing SDM as the norm in obstetrics and midwifery. CONCLUSION(S) The recent UN report advocating a human rights-based approach to end mistreatment and violence against women in reproductive health services has a particular focus on childbirth and obstetric violence. This paper contributes to the recognition of obstetric violence as a human rights violation. It offers conceptual tools to diagnose the impact of gender stereotypes during childbirth and to eliminate women's discrimination in the field of reproductive health.
Collapse
Affiliation(s)
- Stella Villarmea
- Department of Philosophy, University of Oxford, Oxford, UK.,Department of Philosophy, University of Alcala, Madrid, Spain
| | - Brenda Kelly
- Women's & Reproductive Health, University of Oxford, Oxford, UK
| |
Collapse
|