Effect of a population-level performance dashboard intervention on maternal-newborn outcomes: an interrupted time series study

Abstract

ObjectivesTo assess the effect of the Maternal Newborn Dashboard on six key clinical performance indicators in the province of Ontario, Canada.DesignInterrupted time series using population-based data from the provincial birth registry covering a 3-year period before implementation of the Dashboard and 2.5 years after implementation (November 2009 through March 2015).SettingAll hospitals in the province of Ontario providing maternal-newborn care (n=94).InterventionA hospital-based online audit and feedback programme.Main outcome measuresRates of the six performance indicators included in the Dashboard.Results2.5 years after implementation, the audit and feedback programme was associated with statistically significant absolute decreases in the rates of episiotomy (decrease of 1.5 per 100 women, 95% CI 0.64 to 2.39), induction for postdates in women who were less than 41 weeks at delivery (decrease of 11.7 per 100 women, 95% CI 7.4 to 16.0), repeat caesarean delivery in low-risk women performed before 39 weeks (decrease of 10.4 per 100 women, 95% CI 9.3 to 11.5) and an absolute increase in the rate of appropriately timed group B streptococcus screening (increase of 2.8 per 100, 95% CI 2.2 to 3.5). The audit and feedback programme did not significantly affect the rates of unsatisfactory newborn screening blood samples or formula supplementation at discharge. No statistically significant effects were observed for the two internal control outcomes or the four external control indicators—in fact, two external control indicators (episiotomy and postdates induction) worsened relative to before implementation.ConclusionAn electronic audit and feedback programme implemented in maternal-newborn hospitals was associated with clinically relevant practice improvements at the provincial level in the majority of targeted indicators.

Using report cards and dashboards to drive quality improvement: lessons learnt and lessons still to learn

“…Identification of such variation in obstetrics was the impetus for Archie Cochrane to start his work 3. In this issue of BMJ Quality & Safety , Weiss and colleagues report an intervention developed to address inappropriate variation in aspects of maternal newborn care across Ontario, Canada’s most populous province 4. The intervention involved systematic collection and analysis of administrative data to assess key quality indicators for all hospital births in the province and provision of this data in a ‘dashboard’ back to hospitals.…”

Segmented Linear Regression Models for Assessing Change in Retrospective Studies in Healthcare

“…The first limitation of the proposed method is that it cannot capture change that is more complex than envisaged by two adjoining segments, (for example, multiple segmental trends or exponential trends) [18, 20]. In principle, the method can be extended to incorporate three or more segments, but in embracing higher complexity, one risks yielding unnecessary and meaningless information.…”

A National Vision for Quality Improvement in Canadian Nephrology—The Canadian Nephrology Quality Improvement and Implementation Science Collaborative (CN-QUIS): An Opinion Piece

“…For example, securing funds to hire a dedicated QI administrator (whose role exists in several provinces) would allow each workgroup more time to focus on their underlying deliverables as well as help promote cohesion and communication between groups. Such changes in workflow may not be easy, but large-scale QI collaboratives facing similar challenges have been successful in nephrology and other medical specialties, [21][22][23] demonstrating the breadth and potential of what can be accomplished. In QI, it is often said that every system is perfectly designed to deliver the results it gets.…”