Patient involvement and medical practice variation

Brabers, Adriana E.M.

doi:10.26481/dis.20180322ab

Cited by 2 publications

(2 citation statements)

References 9 publications

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“…Therefore, the next step in the VALID project will be to unravel the mechanisms that contribute to the observed practice variation, taking into account the social contexts of the MCNs and differences in population or policy. We use a sociological model for understanding practice variation that includes mechanisms in professionals and their local MCNs as well as in women, including the process of shared decision-making [52]. Insights in these mechanisms will help to define recommendations to optimize decision-making for IOL, and may reduce unwarranted practice variation in IOL.…”

Section: Plos Onementioning

confidence: 99%

Regional practice variation in induction of labor in the Netherlands: Does it matter? A multilevel analysis of the association between induction rates and perinatal and maternal outcomes

Offerhaus¹,

Haken²,

Jong³

et al. 2023

PLoS ONE

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Background Practice variation in healthcare is a complex issue. We focused on practice variation in induction of labor between maternity care networks in the Netherlands. These collaborations of hospitals and midwifery practices are jointly responsible for providing high-quality maternity care. We explored the association between induction rates and maternal and perinatal outcomes. Methods In a retrospective population-based cohort study, we included records of 184,422 women who had a singleton, vertex birth of their first child after a gestation of at least 37 weeks in the years 2016–2018. We calculated induction rates for each maternity care network. We divided networks in induction rate categories: lowest (Q1), moderate (Q2-3) and highest quartile (Q4). We explored the association of these categories with unplanned caesarean sections, unfavorable maternal outcomes and adverse perinatal outcomes using descriptive statistics and multilevel logistic regression analysis corrected for population characteristics. Findings The induction rate ranged from 14.3% to 41.1% (mean 24.4%, SD 5.3). Women in Q1 had fewer unplanned caesarean sections (Q1: 10.2%, Q2-3: 12.1%; Q4: 12.8%), less unfavorable maternal outcomes (Q1: 33.8%; Q2-3: 35.7%; Q4: 36.3%) and less adverse perinatal outcomes (Q1: 1.0%; Q2-3: 1.1%; Q4: 1.3%). The multilevel analysis showed a lower unplanned caesarean section rate in Q1 in comparison with reference category Q2-3 (OR 0.83; p = .009). The unplanned caesarean section rate in Q4 was similar to the reference category. No significant associations with unfavorable maternal or adverse perinatal outcomes were observed. Conclusion Practice variation in labor induction is high in Dutch maternity care networks, with limited association with maternal outcomes and no association with perinatal outcomes. Networks with low induction rates had lower unplanned caesarean section rates compared to networks with moderate rates. Further in-depth research is necessary to understand the mechanisms that contribute to practice variation and the observed association with unplanned caesarean sections.

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Section: Plos Onementioning

confidence: 99%

Regional practice variation in induction of labor in the Netherlands: Does it matter? A multilevel analysis of the association between induction rates and perinatal and maternal outcomes

Offerhaus¹,

Haken²,

Jong³

et al. 2023

PLoS ONE

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show abstract

“…The local context of social norms and available capacity influences physician’s behaviour in their daily practice by providing constraints and opportunities (Westert and Groenewegen, 1999). Next to this, recent research showed that patient involvement in medical decision-making influences the decision taken and therefore the variation (Brabers, 2018). …”

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confidence: 99%