TY - JOUR
T1 - Development and Measurement of Guidelines-Based Quality Indicators of Caesarean Section Care in the Netherlands
T2 - A RAND-Modified Delphi Procedure and Retrospective Medical Chart Review
AU - Melman, Sonja
AU - Schoorel, Ellen C. N.
AU - de Boer, Karin
AU - Burggraaf, Henriette
AU - Derks, Jan B.
AU - van Dijk, Det
AU - van Dillen, Jeroen
AU - Dirksen, Carmen D.
AU - Duvekot, Johannes J.
AU - Franx, Arie
AU - Hasaart, Tom H. M.
AU - Huisjes, Anjoke J. M.
AU - Kolkman, Diny
AU - van Kuijk, Sander
AU - Kwee, Anneke
AU - Mol, Ben W.
AU - van Pampus, Marille G.
AU - de Roon-Immerzeel, Alieke
AU - van Roosmalen, Jos J. M.
AU - Roumen, Frans J. M. E.
AU - Smid-Koopman, Ellen
AU - Smits, Luc
AU - Spaans, Wilbert A.
AU - Visser, Harry
AU - van Wijngaarden, Wim J.
AU - Willekes, Christine
AU - Wouters, Maurice G. A. J.
AU - Nijhuis, Jan G.
AU - Hermens, Rosella P. M. G.
AU - Scheepers, Hubertina C. J.
PY - 2016/1/19
Y1 - 2016/1/19
N2 - BackgroundThere is an ongoing discussion on the rising CS rate worldwide. Suboptimal guideline adherence may be an important contributor to this rise. Before improvement of care can be established, optimal CS care in different settings has to be defined. This study aimed to develop and measure quality indicators to determine guideline adherence and identify target groups for improvement of care with direct effect on caesarean section (CS) rates.MethodEighteen obstetricians and midwives participated in an expert panel for systematic CS quality indicator development according to the RAND-modified Delphi method. A multi-center study was performed and medical charts of 1024 women with a CS and a stratified and weighted randomly selected group of 1036 women with a vaginal delivery were analysed. Quality indicator frequency and adherence were scored in 2060 women with a CS or vaginal delivery.ResultsThe expert panel developed 16 indicators on planned CS and 11 indicators on unplanned CS. Indicator adherence was calculated, defined as the number of women in a specific obstetrical situation in which care was performed as recommended in both planned and unplanned CS settings. The most frequently occurring obstetrical situations with low indicator adherence were: 1) suspected fetal distress (frequency 17%, adherence 46%), 2) nonprogressive labour (frequency 12%, CS performed too early in over 75%), 3) continuous support during labour (frequency 88%, adherence 37%) and 4) previous CS (frequency 12%), with adequate counselling in 15%.ConclusionsWe identified four concrete target groups for improvement of obstetrical care, which can be used as a starting point to reduce CS rates worldwide.
AB - BackgroundThere is an ongoing discussion on the rising CS rate worldwide. Suboptimal guideline adherence may be an important contributor to this rise. Before improvement of care can be established, optimal CS care in different settings has to be defined. This study aimed to develop and measure quality indicators to determine guideline adherence and identify target groups for improvement of care with direct effect on caesarean section (CS) rates.MethodEighteen obstetricians and midwives participated in an expert panel for systematic CS quality indicator development according to the RAND-modified Delphi method. A multi-center study was performed and medical charts of 1024 women with a CS and a stratified and weighted randomly selected group of 1036 women with a vaginal delivery were analysed. Quality indicator frequency and adherence were scored in 2060 women with a CS or vaginal delivery.ResultsThe expert panel developed 16 indicators on planned CS and 11 indicators on unplanned CS. Indicator adherence was calculated, defined as the number of women in a specific obstetrical situation in which care was performed as recommended in both planned and unplanned CS settings. The most frequently occurring obstetrical situations with low indicator adherence were: 1) suspected fetal distress (frequency 17%, adherence 46%), 2) nonprogressive labour (frequency 12%, CS performed too early in over 75%), 3) continuous support during labour (frequency 88%, adherence 37%) and 4) previous CS (frequency 12%), with adequate counselling in 15%.ConclusionsWe identified four concrete target groups for improvement of obstetrical care, which can be used as a starting point to reduce CS rates worldwide.
KW - VAGINAL BIRTH
KW - HEALTH-CARE
KW - DELIVERY
KW - RATES
KW - INTERVENTIONS
KW - REDUCE
KW - TRENDS
U2 - 10.1371/journal.pone.0145771
DO - 10.1371/journal.pone.0145771
M3 - Article
C2 - 26783742
SN - 1932-6203
VL - 11
JO - PLoS ONE [E]
JF - PLoS ONE [E]
IS - 1
M1 - 0145771
ER -