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Assessing the performance of maternity care in Europe: a critical exploration of tools and indicators.

Escuriet R, White J, Beeckman K, Frith L, Leon-Larios F, Loytved C, Luyben A, Sinclair M, van Teijlingen E, EU COST Action IS0907. ‘Childbirth Cultures, Concerns, and Consequence - BMC Health Serv Res (2015)

Bottom Line: Vaginal birth (no instruments) was occasionally cited as an indicator; besides this measurement few of the 388 indicators were found to be assessing non-intervention or "good" or positive outcomes more generally.The tools and indicators identified largely enable measurement of technical interventions and undesirable health (or pathological medical) outcomes.A need was identified for indicators which capture non-intervention, reflecting the reality that most births are low-risk, requiring few, if any, technical medical procedures.

View Article: PubMed Central - PubMed

Affiliation: Directorate-General for Health Planning and Research, Ministry of Health of the Government of Catalonia, Barcelona, Spain. rescuriet@catsalut.cat.

ABSTRACT

Background: This paper critically reviews published tools and indicators currently used to measure maternity care performance within Europe, focusing particularly on whether and how current approaches enable systematic appraisal of processes of minimal (or non-) intervention in support of physiological or "normal birth". The work formed part of COST Actions IS0907: "Childbirth Cultures, Concerns, and Consequences: Creating a dynamic EU framework for optimal maternity care" (2011-2014) and IS1405: Building Intrapartum Research Through Health - an interdisciplinary whole system approach to understanding and contextualising physiological labour and birth (BIRTH) (2014-). The Actions included the sharing of country experiences with the aim of promoting salutogenic approaches to maternity care.

Methods: A structured literature search was conducted of material published between 2005 and 2013, incorporating research databases, published documents in english in peer-reviewed international journals and indicator databases which measured aspects of health care at a national and pan-national level. Given its emergence from two COST Actions the work, inevitably, focused on Europe, but findings may be relevant to other countries and regions.

Results: A total of 388 indicators were identified, as well as seven tools specifically designed for capturing aspects of maternity care. Intrapartum care was the most frequently measured feature, through the application of process and outcome indicators. Postnatal and neonatal care of mother and baby were the least appraised areas. An over-riding focus on the quantification of technical intervention and adverse or undesirable outcomes was identified. Vaginal birth (no instruments) was occasionally cited as an indicator; besides this measurement few of the 388 indicators were found to be assessing non-intervention or "good" or positive outcomes more generally.

Conclusions: The tools and indicators identified largely enable measurement of technical interventions and undesirable health (or pathological medical) outcomes. A physiological birth generally necessitates few, or no, interventions, yet most of the indicators presently applied fail to capture (a) this phenomenon, and (b) the relationship between different forms and processes of care, mode of birth and good or positive outcomes. A need was identified for indicators which capture non-intervention, reflecting the reality that most births are low-risk, requiring few, if any, technical medical procedures.

No MeSH data available.


Flow-Chart of indicators and tools
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Fig2: Flow-Chart of indicators and tools

Mentions: The review uncovered a total of 388 indicators, 383 measuring structure, process and outcome and a further five measuring user satisfaction. Some of these indicators were grouped within tools (a total of seven tools). In addition, 13 distinct tools were identified which exclusively measured satisfaction with maternity care (Fig. 2). Although indicators of user satisfaction are generally considered within the category of care outcomes we chose to analyse tools related to satisfaction and their associated indicators separately in a different paper (now forming part of the work of COST Action IS1405) due to the methodological and analytical complexity of this topic, discussed in more detail below.Fig. 2


Assessing the performance of maternity care in Europe: a critical exploration of tools and indicators.

Escuriet R, White J, Beeckman K, Frith L, Leon-Larios F, Loytved C, Luyben A, Sinclair M, van Teijlingen E, EU COST Action IS0907. ‘Childbirth Cultures, Concerns, and Consequence - BMC Health Serv Res (2015)

Flow-Chart of indicators and tools
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4631101&req=5

Fig2: Flow-Chart of indicators and tools
Mentions: The review uncovered a total of 388 indicators, 383 measuring structure, process and outcome and a further five measuring user satisfaction. Some of these indicators were grouped within tools (a total of seven tools). In addition, 13 distinct tools were identified which exclusively measured satisfaction with maternity care (Fig. 2). Although indicators of user satisfaction are generally considered within the category of care outcomes we chose to analyse tools related to satisfaction and their associated indicators separately in a different paper (now forming part of the work of COST Action IS1405) due to the methodological and analytical complexity of this topic, discussed in more detail below.Fig. 2

Bottom Line: Vaginal birth (no instruments) was occasionally cited as an indicator; besides this measurement few of the 388 indicators were found to be assessing non-intervention or "good" or positive outcomes more generally.The tools and indicators identified largely enable measurement of technical interventions and undesirable health (or pathological medical) outcomes.A need was identified for indicators which capture non-intervention, reflecting the reality that most births are low-risk, requiring few, if any, technical medical procedures.

View Article: PubMed Central - PubMed

Affiliation: Directorate-General for Health Planning and Research, Ministry of Health of the Government of Catalonia, Barcelona, Spain. rescuriet@catsalut.cat.

ABSTRACT

Background: This paper critically reviews published tools and indicators currently used to measure maternity care performance within Europe, focusing particularly on whether and how current approaches enable systematic appraisal of processes of minimal (or non-) intervention in support of physiological or "normal birth". The work formed part of COST Actions IS0907: "Childbirth Cultures, Concerns, and Consequences: Creating a dynamic EU framework for optimal maternity care" (2011-2014) and IS1405: Building Intrapartum Research Through Health - an interdisciplinary whole system approach to understanding and contextualising physiological labour and birth (BIRTH) (2014-). The Actions included the sharing of country experiences with the aim of promoting salutogenic approaches to maternity care.

Methods: A structured literature search was conducted of material published between 2005 and 2013, incorporating research databases, published documents in english in peer-reviewed international journals and indicator databases which measured aspects of health care at a national and pan-national level. Given its emergence from two COST Actions the work, inevitably, focused on Europe, but findings may be relevant to other countries and regions.

Results: A total of 388 indicators were identified, as well as seven tools specifically designed for capturing aspects of maternity care. Intrapartum care was the most frequently measured feature, through the application of process and outcome indicators. Postnatal and neonatal care of mother and baby were the least appraised areas. An over-riding focus on the quantification of technical intervention and adverse or undesirable outcomes was identified. Vaginal birth (no instruments) was occasionally cited as an indicator; besides this measurement few of the 388 indicators were found to be assessing non-intervention or "good" or positive outcomes more generally.

Conclusions: The tools and indicators identified largely enable measurement of technical interventions and undesirable health (or pathological medical) outcomes. A physiological birth generally necessitates few, or no, interventions, yet most of the indicators presently applied fail to capture (a) this phenomenon, and (b) the relationship between different forms and processes of care, mode of birth and good or positive outcomes. A need was identified for indicators which capture non-intervention, reflecting the reality that most births are low-risk, requiring few, if any, technical medical procedures.

No MeSH data available.