National perinatal audit, a feasible initiative for the Netherlands!? A validation study

Diem, Mariet van; Reu, Paul De; Eskes, Martine; Brouwers, H. A. A.; Holleboom, C.A.G.; Slagter-Roukema, Tineke; Merkus, Hans M.W.M.

doi:10.3109/00016349.2010.500468

Cited by 11 publications

(13 citation statements)

References 13 publications

(11 reference statements)

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“…The grey-shaded bars on the background of the graphs indicate influenza epidemic episodes (defined as −3/+3 weeks around successive weeks with an overall ILI-incidence ≥5.1/10,000 population); only ILI-incidence in these episodes was included in the models. The strong downward timetrend in 0–4 yrs of age seems mainly due to a decrease of 39% in neonatal deaths in the last decade as reported by the national perinatal audit [45].…”

Section: Resultsmentioning

confidence: 93%

Comparing Pandemic to Seasonal Influenza Mortality: Moderate Impact Overall but High Mortality in Young Children

et al. 2012

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BackgroundWe assessed the severity of the 2009 influenza pandemic by comparing pandemic mortality to seasonal influenza mortality. However, reported pandemic deaths were laboratory-confirmed – and thus an underestimation – whereas seasonal influenza mortality is often more inclusively estimated. For a valid comparison, our study used the same statistical methodology and data types to estimate pandemic and seasonal influenza mortality.Methods and FindingsWe used data on all-cause mortality (1999–2010, 100% coverage, 16.5 million Dutch population) and influenza-like-illness (ILI) incidence (0.8% coverage). Data was aggregated by week and age category. Using generalized estimating equation regression models, we attributed mortality to influenza by associating mortality with ILI-incidence, while adjusting for annual shifts in association. We also adjusted for respiratory syncytial virus, hot/cold weather, other seasonal factors and autocorrelation. For the 2009 pandemic season, we estimated 612 (range 266–958) influenza-attributed deaths; for seasonal influenza 1,956 (range 0–3,990). 15,845 years-of-life-lost were estimated for the pandemic; for an average seasonal epidemic 17,908. For 0–4 yrs of age the number of influenza-attributed deaths during the pandemic were higher than in any seasonal epidemic; 77 deaths (range 61–93) compared to 16 deaths (range 0–45). The ≥75 yrs of age showed a far below average number of deaths. Using pneumonia/influenza and respiratory/cardiovascular instead of all-cause deaths consistently resulted in relatively low total pandemic mortality, combined with high impact in the youngest age category.ConclusionThe pandemic had an overall moderate impact on mortality compared to 10 preceding seasonal epidemics, with higher mortality in young children and low mortality in the elderly. This resulted in a total number of pandemic deaths far below the average for seasonal influenza, and a total number of years-of-life-lost somewhat below average. Comparing pandemic and seasonal influenza mortality as in our study will help assessing the worldwide impact of the 2009 pandemic.

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Section: Resultsmentioning

confidence: 93%

Comparing Pandemic to Seasonal Influenza Mortality: Moderate Impact Overall but High Mortality in Young Children

et al. 2012

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“…The perinatal mortality decreased from 13.8 to 7.7 per 1000 live births with better cooperation between hospitals and the implementation of nationwide protocols attributed to the audit process. Nationwide perinatal mortality audits in the Netherlands are the result of a joint effort by government and professional colleges to implement audit in all of the country's 90 obstetric units [ 30 , 31 ]. The MBRRACE-UK (Mothers and Babies Reducing Risk through Audit and Confidential Enquiries across the United Kingdom) has just taken over the long existing confidential enquiries which anonymously investigate maternal deaths, stillbirths and infant deaths.…”

Section: Resultsmentioning

confidence: 99%

Counting every stillbirth and neonatal death through mortality audit to improve quality of care for every pregnant woman and her baby

Kerber

Mathai

Lewis

et al. 2015

BMC Pregnancy Childbirth

106

158

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BackgroundWhile there is widespread acknowledgment of the need for improved quality and quantity of information on births and deaths, there has been less movement towards systematically capturing and reviewing the causes and avoidable factors linked to deaths, in order to affect change. This is particularly true for stillbirths and neonatal deaths which can fall between different health care providers and departments. Maternal and perinatal mortality audit applies to two of the five objectives in the Every Newborn Action Plan but data on successful approaches to overcome bottlenecks to scaling up audit are lacking.MethodsWe reviewed the current evidence for facility-based perinatal mortality audit with a focus on low- and middle-income countries and assessed the status of mortality audit policy and implementation. Based on challenges identified in the literature, key challenges to completing the audit cycle and affecting change were identified across the WHO health system building blocks, along with solutions, in order to inform the process of scaling up this strategy with attention to quality.ResultsMaternal death surveillance and review is moving rapidly with many countries enacting and implementing policies and with accountability beyond the single facility conducting the audits. While 51 priority countries report having a policy on maternal death notification in 2014, only 17 countries have a policy for reporting and reviewing stillbirths and neonatal deaths. The existing evidence demonstrates the potential for audit to improve birth outcomes, only if the audit cycle is completed. The primary challenges within the health system building blocks are in the area of leadership and health information. Examples of successful implementation exist from high income countries and select low- and middle-income countries provide valuable learning, especially on the need for leadership for effective audit systems and on the development and the use of clear guidelines and protocols in order to ensure that the audit cycle is completed.ConclusionsHealth workers have the power to change health care routines in daily practice, but this must be accompanied by concrete inputs at every level of the health system. The system requires data systems including consistent cause of death classification and use of best practice guidelines to monitor performance, as well as leaders to champion the process, especially to ensure a no-blame environment, and to access change agents at other levels to address larger, systemic challenges.

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“… 10–12 Recently, the professional organisations involved jointly prepared a nationwide perinatal mortality audit programme that would become a standard part of perinatal care. 13–17 The Foundation Perinatal Audit in the Netherlands (PAN) was set up by the professional organisations of midwives, general practitioners, obstetricians, paediatricians and pathologists ( http://www.perinataleaudit.nl ). The first nationwide Dutch perinatal mortality audit started in the period 2010–2012 with a focus on audit of term perinatal deaths.…”

Section: Introductionmentioning

confidence: 99%

Term perinatal mortality audit in the Netherlands 2010–2012: a population-based cohort study

Eskes

Waelput²,

Erwich

et al. 2014

BMJ Open

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ObjectiveTo assess the implementation and first results of a term perinatal internal audit by a standardised method.DesignPopulation-based cohort study.SettingAll 90 Dutch hospitals with obstetric/paediatric departments linked to community practices of midwives, general practitioners in their attachment areas, organised in perinatal cooperation groups (PCG).PopulationThe population consisted of 943 registered term perinatal deaths occurring in 2010–2012 with detailed information, including 707 cases with completed audit results.Main outcome measuresParticipation in the audit, perinatal death classification, identification of substandard factors (SSF), SSF in relation to death, conclusive recommendations for quality improvement in perinatal care and antepartum risk selection at the start of labour.ResultsAfter the introduction of the perinatal audit in 2010, all PCGs participated. They organised 645 audit sessions, with an average of 31 healthcare professionals per session. Of all 1102 term perinatal deaths (2.3/1000) data were registered for 86% (943) and standardised anonymised audit results for 64% (707). In 53% of the cases at least one SSF was identified. Non-compliance to guidelines (35%) and deviation from usual professional care (41%) were the most frequent SSF. There was a (very) probable relation between the SSF and perinatal death for 8% of all cases. This declined over the years: from 10% (n=23) in 2010 to 5% (n=10) in 2012 (p=0.060). Simultaneously term perinatal mortality decreased from 2.3 to 2.0/1000 births (p<0.00001). Possibilities for improvement were identified in the organisation of care (35%), guidelines or usual care (19%) and in documentation (15%). More pregnancies were antepartum selected as high risk, 70% in 2010 and 84% in 2012 (p=0.0001).ConclusionsThe perinatal audit is implemented nationwide in all obstetrical units in the Netherlands in a short time period. It is possible that the audit contributed to the decrease in term perinatal mortality.

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National perinatal audit, a feasible initiative for the Netherlands!? A validation study

Abstract: Perinatal audit on a national level with relatively large audit groups with many different care providers is feasible.

Cited by 11 publications

References 13 publications

Comparing Pandemic to Seasonal Influenza Mortality: Moderate Impact Overall but High Mortality in Young Children

Comparing Pandemic to Seasonal Influenza Mortality: Moderate Impact Overall but High Mortality in Young Children

Counting every stillbirth and neonatal death through mortality audit to improve quality of care for every pregnant woman and her baby

Term perinatal mortality audit in the Netherlands 2010–2012: a population-based cohort study

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