Monitoring quality of obstetric care from hospital discharge databases: A Delphi survey to propose a new set of indicators based on maternal health outcomes

Priscille Sauvegrain; Anne Alice Chantry; Coralie Chiesa-Dubruille; Hawa Keita; François Goffinet; Catherine Deneux-Tharaux

doi:10.1371/journal.pone.0211955

Monitoring quality of obstetric care from hospital discharge databases: A Delphi survey to propose a new set of indicators based on maternal health outcomes

PLoS One. 2019 Feb 12;14(2):e0211955. doi: 10.1371/journal.pone.0211955. eCollection 2019.

Authors

Priscille Sauvegrain^{1

2}, Anne Alice Chantry^{1

3}, Coralie Chiesa-Dubruille¹, Hawa Keita^{4

5}, François Goffinet^{1

6}, Catherine Deneux-Tharaux¹

Affiliations

¹ Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé) Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France.
² Department of Obstetrics and Gynecology, AP-HP Pitié-Salpêtrière, Paris, France.
³ School of Midwives, Baudelocque, AP-HP, University of Paris Descartes, DHU Risks in Pregnancy, Paris, France.
⁴ Department of Anesthesia and reanimation, AP-HP Louis Mourier, DHU Risks in Pregnancy, Colombes, France.
⁵ Paris Diderot university, Sorbonne Paris Cité, EA 7334 Recherche Clinique coordonnée ville-hôpital, Méthodologies et Société (REMES), Paris, France.
⁶ Department of Obstetrics and Gynecology, AP-HP Cochin-Port Royal, DHU Risks in Pregnancy, Paris, France.

Abstract

Objectives: Most indicators proposed for assessing quality of care in obstetrics are process indicators and do not directly measure health effects, and cannot always be identified from routinely available databases. Our objective was to propose a set of indicators to assess the quality of hospital obstetric care from maternal morbidity outcomes identifiable in permanent hospital discharge databases.

Methods: Various maternal morbidity outcomes potentially reflecting quality of obstetric care were first selected from a systematic literature review. Then a three-round Delphi consensus survey was conducted online from 11/2016 through 02/2017 among a French panel of 37 expert obstetricians, anesthetists-critical-care specialists, midwives, quality-of-care researchers, and user representatives. For a given maternal outcome, several definitions could be proposed and the indicator (i.e. corresponding rate) could be applied to all women or restricted to specific subgroup(s).

Results: Of the 49 experts invited to participate, 37 agreed. The response rate was 92% in the second round and 97% in the third. Finally, a set of 13 indicators was selected to assess the quality of hospital obstetric care: rates of uterine rupture, postpartum hemorrhage, transfusion incident, severe perineal lacerations, episiotomy, cesarean, cesarean under general anesthesia, post-cesarean site infection, anesthesia-related complications, postpartum pulmonary embolism, maternal readmission and maternal mortality. Six were considered in specific subgroups, with, for example, the postpartum hemorrhage rate assessed among all women and also among women at low risk of PPH.

Implications: This Delphi process enabled us to define consensually a set of indicators to assess the quality of hospital obstetrics care from routine hospital data, based on maternal morbidity outcomes. Considering 6 of them in specific subgroups of women is especially interesting. These indicators, identifiable through codes used in international classifications, will be useful to monitor quality of care over time and across settings.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Delphi Technique
Female
France
Health Personnel
Humans
Maternal Health / standards*
Maternal Health Services / standards*
Maternal Mortality
Patient Discharge
Postnatal Care
Pregnancy
Pregnancy Complications / therapy*
Quality Indicators, Health Care
Systematic Reviews as Topic

Grants and funding

The Momassi project received funding from the French Directorate-General for the organization of care as part of a research program on the performance of the System of specific care to indicators of the quality and safety of care (PREPS-IQ 2013 n°1358). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.