Standardized outcome measures for pregnancy and childbirth, an ICHOM proposal

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Abstract

Background

Value-based health care aims to optimize the balance of patient outcomes and health care costs. To improve value in perinatal care using this strategy, standard outcomes must first be defined. The objective of this work was to define a minimum, internationally appropriate set of outcome measures for evaluating and improving perinatal care with a focus on outcomes that matter to women and their families.

Methods

An interdisciplinary and international Working Group was assembled. Existing literature and current measurement initiatives were reviewed. Serial guided discussions and validation surveys provided consumer input. A series of nine teleconferences, incorporating a modified Delphi process, were held to reach consensus on the proposed Standard Set.

Results

The Working Group selected 24 outcome measures to evaluate care during pregnancy and up to 6 months postpartum. These include clinical outcomes such as maternal and neonatal mortality and morbidity, stillbirth, preterm birth, birth injury and patient-reported outcome measures (PROMs) that assess health-related quality of life (HRQoL), mental health, mother-infant bonding, confidence and success with breastfeeding, incontinence, and satisfaction with care and birth experience. To support analysis of these outcome measures, pertinent baseline characteristics and risk factor metrics were also defined.

Conclusions

We propose a set of outcome measures for evaluating the care that women and infants receive during pregnancy and the postpartum period. While validation and refinement via pilot implementation projects are needed, we view this as an important initial step towards value-based improvements in care.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3732-3) contains supplementary material, which is available to authorized users.

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Most cited references 26

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Author and article information

Contributors

Malini Anand Nijagal: Malini.Nijagal@ucsf.edu

Stephanie Wissig: s.wissig@gmail.com

Caleb Stowell: caleb.stowell@gmail.com

Elizabeth Olson: elizabeth.m.olson@outlook.com

Isis Amer-Wahlin: Isis.Amer-wahlin@ki.se

Gouke Bonsel: bonsel@euroqol.org

Allyson Brooks: Allyson.Brooks@Hoag.org

Matthew Coleman: Matthew.Coleman@uhs.nhs.uk

Shamala Devi Karalasingam: shamaladevi@crc.gov.my

James M N Duffy: James.duffy@balliol.ox.ac.uk

Tracy Flanagan: Tracy.Flanagan@kp.org

Stefan Gebhardt: gsgeb@sun.ac.za

Meridith E Greene: meridithemilie@gmail.com

Floris Groenendaal: F.Groenendaal@umcutrecht.nl

J Ravichandran R Jeganathan: drjravi@gmail.com

Tessa Kowaliw: tessakowaliw@gmail.com

Marije Lamain-de-Ruiter: M.deRuiter-7@umcutrecht.nl

Elliott Main: main@cmqcc.org

Michelle Owens: Michelle.y.owens@gmail.com

Rod Petersen: rodneywpetersen@gmail.com

Irwin Reiss: i.reiss@erasmusmc.nl

Carol Sakala: csakala@nationalpartnership.org

Anna Maria Speciale: aspeciale@pathfinder.org

Rachel Thompson: Rachel.L.Thompson@dartmouth.edu

Oluwakemi Okunade: o.okunade@ichom.org

Arie Franx:

ORCID: http://orcid.org/0000-0001-8801-5546

+31 088 75 564 26 , A.Franx-2@umcutrecht.nl

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 11 December 2018

Publication date PMC-release: 11 December 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 953

Affiliations

[1 ]ISNI 0000 0001 2297 6811, GRID grid.266102.1, University of California, Zuckerberg San Francisco General Hospital, ; San Francisco, CA USA

[2 ]International Consortium for Health Outcomes Measurement, Cambridge, MA USA

[3 ]ISNI 0000 0004 1937 0626, GRID grid.4714.6, Karolinska Institutet, ; Stockholm, Sweden

[4 ]ISNI 000000040459992X, GRID grid.5645.2, Erasmus Medical Center, ; Rotterdam, Netherlands

[5 ]ISNI 0000 0000 9755 6590, GRID grid.414587.b, Hoag Memorial Hospital Presbyterian, ; Newport Beach, CA USA

[6 ]ISNI 0000000103590315, GRID grid.123047.3, University Hospital Southampton, ; Hampshire, UK

[7 ]ISNI 0000 0001 0690 5255, GRID grid.415759.b, National Clinical Research Centre, Ministry of Health, ; Kuala Lumpur, Malaysia

[8 ]ISNI 0000 0004 1936 8948, GRID grid.4991.5, Balliol College, University of Oxford, ; Oxford, UK

[9 ]ISNI 0000 0004 1936 8948, GRID grid.4991.5, Nuffield Department of Primary Care Health Sciences, , University of Oxford, ; Oxford, UK

[10 ]ISNI 0000 0004 0442 6914, GRID grid.477490.9, Kaiser Permanente, ; Richmond, CA USA

[11 ]ISNI 0000 0001 2214 904X, GRID grid.11956.3a, Stellenbosch University and Tygerberg Hospital, ; Cape Town, South Africa

[12 ]ISNI 0000 0004 0386 9924, GRID grid.32224.35, Massachusetts General Hospital, ; Boston, MA USA

[13 ]ISNI 0000000090126352, GRID grid.7692.a, University Medical Center Utrecht, ; Utrecht, Netherlands

[14 ]ISNI 0000 0004 0621 7083, GRID grid.413461.5, Sultanah Aminah Hospital, Johor Ministry of Health, ; Johor Bahru, Malaysia

[15 ]South Australian Maternity Reform Association (SAMRA) Inc, Adelaide, Australia

[16 ]California Maternal Quality Care Collaborative, Stanford, CA USA

[17 ]ISNI 0000 0004 1937 0407, GRID grid.410721.1, University of Mississippi Medical Center, ; Jackson, MS USA

[18 ]Women and Children’s Health Network, North Adelaide, South Australia

[19 ]ISNI 0000 0004 0624 7135, GRID grid.475933.f, National Partnership for Women & Families, ; Washington, D.C., USA

[20 ]ISNI 0000 0001 2160 9155, GRID grid.488396.8, American College of Nurse Midwives, ; Silver Spring, MD USA

[21 ]GRID grid.414049.c, The Dartmouth Institute for Health Policy and Clinical Practice, ; Lebanon, NH USA

[22 ]ISNI 0000 0004 0620 3132, GRID grid.417100.3, Wilhelmina Children’s Hospital, University Medical Center Utrecht, ; Utrecht, 3508 AB The Netherlands

[23 ]ISNI 0000 0001 2175 4264, GRID grid.411024.2, University of Maryland School of Medicine, ; Baltimore, MD 21201 USA

Author information

Arie Franx http://orcid.org/0000-0001-8801-5546

Article

Publisher ID: 3732

DOI: 10.1186/s12913-018-3732-3

PMC ID: 6290550

PubMed ID: 30537958

SO-VID: 62a5ec20-697f-40e0-b5f2-c854a671dc11

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 8 March 2018

Date accepted : 19 November 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100008132, HCF Research Foundation;

Funded by: SA Health

Funded by: FundRef http://dx.doi.org/10.13039/501100004047, Karolinska Institutet;

Funded by: Hoag Hospital

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: health outcomes,pregnancy,obstetrics,consensus,delivery outcomes,outcome measures,perinatal health,delphi process,patient-centred outcomes,patient-reported

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: health outcomes, pregnancy, obstetrics, consensus, delivery outcomes, outcome measures, perinatal health, delphi process, patient-centred outcomes, patient-reported

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Standardized outcome measures for pregnancy and childbirth, an ICHOM proposal

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Abstract

Background

Methods

Results

Conclusions

Electronic supplementary material

Related collections

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Most cited references 26

Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality.

Validation of the Edinburgh Depression Scale during pregnancy.

Pregnancy-related mortality in the United States, 2006-2010.

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Cited by 68

Most referenced authors 574