Finding the right indicators for assessing quality midwifery care

Bruin-Kooistra, Mieneke de; Amelink-Verburg, M.P.; Buitendijk, S. E.; Westert, Gert P.

doi:10.1093/intqhc/mzs006

Cited by 26 publications

(17 citation statements)

References 19 publications

(22 reference statements)

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“…The data used in the current study were generated from an existing birth record database owing to its ease of access and consistency in data entry [ 23 ]. We investigated the use of episiotomy and occurrence of severe perineal damage, as defined above, as indicators of the quality and effectiveness of maternity care [ 2 , 3 , 5 ]. The rationale for this analysis was that studying trends in relation to these indicators over a period of time could provide some measure of the impact on clinical practice of implementing the SANC recommendations.…”

Section: Discussionmentioning

confidence: 99%

Cross-sectional study comparing public and private hospitals in Catalonia: Is the practice of routine episiotomy changing?

Escuriet

Pueyo

Perez-Botella

et al. 2015

BMC Health Serv Res

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BackgroundIn Spain, the Strategy for Assistance in Normal Childbirth (SANC) promoted a model of care, which respects the physiological birth process and discards unnecessary routine interventions, such as episiotomies. We evaluated the rate of episiotomy use and perineal trauma as indicators of how selective introduction of the SANC initiative has impacted childbirth outcomes in hospitals of Catalonia.MethodsCross-sectional study of all singleton vaginal term deliveries without instrument registered in the Minimum Basic Data Set (MBDS) of Catalonia in 2007, 2010 and 2012. Hospitals were divided into types according to funding (public or private), and four strata were differentiated according to volume of births attended.Episiotomies and perineal injury were considered dependent variables. The relationship between qualitative variables was analysed using the chi-squared test, and Student’s t-test was used for quantitative variables. Comparison of proportions was performed on the two hospital groups between 2007 and 2012 using a Z-test. Logistic regression models were used to analyse the relationship between episiotomy or severe perineal damage and maternal age, volume of births and hospital type, obtaining odds ratios (OR) and 95% confidence intervals (CI).ResultsThe majority of normal singleton term deliveries were attended in public hospitals, where maternal age was lower than for women attended in private hospitals. Analysis revealed a statistically significant (P < 0.001) decreasing trend in episiotomy use in Catalonia for both hospital types. Private hospitals appeared to be associated with increased episiotomy rate in 2007 (OR = 1.099, CI: 1,057–1,142), 2010 (OR = 1.528, CI: 1,472–1,587) and 2012 (OR = 1.459, CI: 1,383–1,540), and a lower rate of severe perineal trauma in 2007 (OR = 0.164, CI: 0.095–0.283), 2010 (OR = 0.16, CI: 0.110–0.232) and 2012 (OR = 0.19, CI: 0.107–0.336). Regarding severe perineal injury, when independent variables were adjusted, maternal age ceased to have a significant correlation in 2012 (OR = 0.994, CI: 0.970–1.018).ConclusionsEpisiotomy procedures during normal singleton vaginal term deliveries in Catalonia has decreased steadily since 2007. Study results show a stable incidence trend below 1% for severe perineal trauma over the study period.

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Section: Discussionmentioning

confidence: 99%

Cross-sectional study comparing public and private hospitals in Catalonia: Is the practice of routine episiotomy changing?

Escuriet

Pueyo

Perez-Botella

et al. 2015

BMC Health Serv Res

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“…It is important to know the opinions of service users. Much of the data used by public administrations in this regard is derived from hospital discharge records, which can be used to establish quality indicators and to examine how practices (in this case, obstetric intervention) may have changed since a new policy was implemented [ 23 , 24 ]. If our aim, as policy makers, is to explore the extent to which maternity services have become more women-centred, then data of this kind cannot provide exhaustive information [ 25 , 26 ], although they do have a role to play provided they are complemented by information obtained from women themselves and from professionals [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of maternity care policy in Catalonia: a retrospective cross-sectional study of service delivery in public and private hospitals

Escuriet

Tricas

Pueyo-Sanchez

et al. 2015

BMC Pregnancy Childbirth

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BackgroundAs a result of the growing number of interventions that are now performed in the context of maternity care, health authorities have begun to examine the possible repercussions for service provision and for maternal and neonatal health. In Spain the Strategy Paper on Normal Childbirth was published in 2008, and since then the authorities in Catalonia have sought to implement its recommendations. This paper reviews the current provision of maternity care in Catalonia.MethodsThis was a descriptive study. Hospitals were grouped according to their source of funding (public or private) and were stratified (across four strata) on the basis of the annual number of births recorded within their respective maternity service. Data regarding the distribution of obstetric professionals were taken from an official government survey of hospitals published in 2010. The data on obstetric interventions (caesarean, use of forceps, vacuum or non-specified instruments) performed in 2007, 2010 and 2012 were obtained by consulting discharge records of 44 public and 20 private hospitals, which together provide care in 98% of all births in Catalonia. Proportions and confidence intervals were calculated for each intervention performed in all full-term (37–42 weeks) singleton births.ResultsAnalysis of staff profiles according to the stratification of hospitals showed that almost all the hospitals had more obstetricians than midwives among their maternity care staff. Public hospitals performed fewer caesareans [range between 19.20% (CI 18.84-19.55) and 28.14% (CI 27.73-28.54)] than did private hospitals [range between 32.21% (CI 31.78-32.63) and 39.43% (CI 38.98-39.87)]. The use of forceps has decreased in public hospitals. The use of a vacuum extractor has increased and is more common in private hospitals.ConclusionsCaesarean section is the most common obstetric intervention performed during full-term singleton births in Catalonia. The observed trend is stable in the group of public hospitals, but shows signs of a rise among private institutions. The number of caesareans performed in accredited public hospitals covers a limited range with a stable trend. Among public hospitals the highest rate of caesareans is found in non-accredited hospitals with a lower annual number of births.

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“…Real-life applications of the presented face valid and acceptable quality indicators should be studied by further research (Campbell et al, 2002;Mainz, 2003a;de Bruin-Kooistra et al, 2012). Each indicator should be examined for the following criteria: reliability of data collection, applicability to a clinic's specific patient population, improvement potential, discriminatory capacity, complexity and case-mix stability (Mourad et al, 2008).…”

Section: Implications For Researchmentioning

confidence: 99%

Quality indicators for all dimensions of infertility care quality: consensus between professionals and patients

Dancet¹,

D’Hooghe²,

Spiessens³

et al. 2013

Human Reproduction

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study question: What is the relative importance of the six dimensions of quality of care according to different stakeholders and can a quality indicator set address all six quality dimensions and incorporate the views from professionals working in different disciplines and from patients?summary answer: Safety, effectiveness and patient centeredness were the most important quality dimensions. All six quality dimensions can be assessed with a set of 24 quality indicators, which is face valid and acceptable according to both professionals from different disciplines and patients.what is known already: To our knowledge, no study has weighted the relative importance of all quality dimensions to infertility care. Additionally, there are very few infertility care-specific quality indicators and no quality indicator set covers all six quality dimensions and incorporated the views of professionals and patients. study design, size and duration: A three-round iterative Delphi survey including patients and professionals from four different fields, conducted in two European countries over the course of 2011 and 2012. participants/materials, settings and methods: Dutch and Belgian gynaecologists, embryologists, counsellors, nurses/midwifes and patients took part (n ¼ 43 in round 1 and finally 30 in round 3). Respondents ranked the six quality dimensions twice for importance and their agreement was evaluated. Furthermore, in round 1, respondents gave suggestions, which were subsequently uniformly formulated as quality indicators. In rounds 2 and 3, respondents rated the quality indicators for preparedness to measure and for importance (relation to quality and prioritization for benchmarking). Providing feedback allowed selecting indicators based on consensus between stakeholder groups. Measurable indicators, important to all stakeholder groups, were selected for each quality dimension.main results: All stakeholder groups and most individuals agreed that safety, effectiveness and patient centeredness were the most important quality dimensions. A total of 498 suggestions led to the development of 298 indicators. Professionals were sufficiently prepared to measure 204 of these indicators. Based on importance, 52 (7-15 per dimension; round 2) and finally 24 (4 per dimension; round 3) quality indicators were selected.limitations, reasons for caution: The final quality indicator set does not cover the entire care process, but rather takes a 'sample' of each quality dimension. Although the quality indicators are face valid and acceptable, their psychometric characteristics need to be tested by further research.wider implications of the findings: Quality management should focus on safety, effectiveness and patient centeredness of care. Clinics can use the quality indicator set to assess all quality dimensions of their care.

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Finding the right indicators for assessing quality midwifery care

Cited by 26 publications

References 19 publications

Cross-sectional study comparing public and private hospitals in Catalonia: Is the practice of routine episiotomy changing?

Cross-sectional study comparing public and private hospitals in Catalonia: Is the practice of routine episiotomy changing?

Impact of maternity care policy in Catalonia: a retrospective cross-sectional study of service delivery in public and private hospitals

Quality indicators for all dimensions of infertility care quality: consensus between professionals and patients

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