A feasibility study of implementing a patient‐centered outcome set for pregnancy and childbirth

Abstract

Background and Aims Patient‐reported outcome and experience measures (PROM and PREM) can facilitate shared decision making and hold potential to improve healthcare quality. However, their adoption in perinatal care is still limited. The International Consortium for Health Outcomes Measurement (ICHOM) developed a Pregnancy and Childbirth (PCB) outcome set, including PROM and PREM questionnaires. We studied the feasibility to use these PROMs/PREMs in Dutch perinatal care, addressing both women's and professionals' perspective. Methods Patients and professionals in primary and hospital care participated. Women under care at one of five timepoints for PROM/PREM collection of the PCB set (2 during pregnancy, 3 postpartum) were e‐mailed a questionnaire and discussed their answers with their obstetric professional the next regular visit. Compliance was recorded. After discussing the PROMs/PREMs, usability and experience were assessed with separate surveys amongst women and professionals. Results Of 26 women approached, 21 completed and discussed their PROM/PREM questionnaire. Mean questionnaire completion rate was 97%. Average reported time completing the questionnaires was 10 minutes; most women (90%) stated this was acceptable. Women preferred completing questionnaires digitally and discuss their answers with an obstetric professional rather than other care professionals, also 6 months postpartum. Over half of women agreed PROMs/PREMs supported shared decision making (58%), ability to raise issues (60%), and patient‐clinician relationship (52%). Six professionals participated: two obstetricians, two clinical midwives, and two community midwives. Most professionals experienced sufficient time to discuss the responses, except at 6 months postpartum. They knew what items to discuss but did not always feel responsible to act upon them. Professionals agreed PROMs/PREMs supported symptom detection and personalized care. Conclusions Patients and obstetric professionals consider the PCB set a feasible instrument for PROM/PREM assessment, with good compliance, acceptability and usability. Important determinants of successful implementation are a well‐equipped ICT‐tool, agreements regarding professionals' responsibilities and how outcomes are discussed or acted upon.

Introducing Patient Reported Measures (PRMs) Into Finnish Public Maternity Service: A Study on Professionals’ Views

“…case-mix variables), which are important and useful in delivering and developing maternity care. Similar results have been reported earlier from Netherlands [23,24]. In particular, PREMs which cover issues like patient's active role, birth experience, and satisfaction [30] were rated by almost all participants as being "important".…”

“…This should be considered in the selection of time points of data collection. Particularly, consistent with Depla et al (2020) [23], our study indicates that collecting data during or just after birth is problematic, causing burdens on women and staff. Instead of collecting PRMs data at six months after the birth, collection sometime between two to four months postpartum would be more practical, as this is the time frame for the nal maternal checkup offered in Finland.…”

“…Although ICHOM has provided a reference guide with hands-on materials [22] to facilitate the process of implementing this standard set into routine practice, a complete pre-implementation investigation of local acceptability and applicability is required. Until recently, we are aware of only few studies assessing the local implementation of the PRMs de ned in ICHOM PCB outcome set [23][24][25]. The implementation of PRMs are affected by a wide range of factors, e.g.…”

A qualitative study on professionals’ attitudes and views towards the introduction of patient reported measures into public maternity care pathway

“…Although the importance and potential benefits of integrating PRMs into healthcare outcome measurement and evaluation have been widely acknowledged and use of PRMs has rapidly grown in recent decades, applicable knowledge and experience of structurally and routinely collecting and using PRMs data in clinical practices are still limited [ 2 ]. Most of the PRMs-implementation studies published in the past decade focus on particular medical areas, such as oncology, palliative care, mental health, and chronic diseases [ 13 , 14 ], or on specific medical stages or clinical episodes, such as elective surgery [ 5 ]. Research-based evidence of acceptability, feasibility, and impact of implementing PRMs across the pathway of pregnancy and childbirth is still insufficient, and context-sensitive strategies and practices of successfully integrating PRMs into maternity care routine are also lacking [ 13 ].…”

“…Most of the PRMs-implementation studies published in the past decade focus on particular medical areas, such as oncology, palliative care, mental health, and chronic diseases [ 13 , 14 ], or on specific medical stages or clinical episodes, such as elective surgery [ 5 ]. Research-based evidence of acceptability, feasibility, and impact of implementing PRMs across the pathway of pregnancy and childbirth is still insufficient, and context-sensitive strategies and practices of successfully integrating PRMs into maternity care routine are also lacking [ 13 ].…”