Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Mar 4, 2022
Date Accepted: May 31, 2022
Patient reported outcome and experience measures in perinatal care to guide clinical practice: the first results
ABSTRACT
Background:
The International Consortium for Health Outcomes Measurement (ICHOM) published a set of patient-centered outcome measures for pregnancy and childbirth (PCB set), including patient reported outcome and experience measures (PROM and PREM). To establish value-based pregnancy and childbirth care, the PCB set was implemented in the Netherlands, using the outcomes on patient level for shared decision making and on an aggregated level for quality improvement.
Objective:
This study aimed to report first outcomes, experiences, and practice insights of implementing the PCB set in clinical practice.
Methods:
Seven obstetric care networks across the Netherlands, each consisting of one or two hospitals and multiple community midwifery practices (2-18), implemented the PROM and PREM of the PCB set as part of clinical routine. This observational study included all women participating in the clinical project. PROM and PREM were assessed with questionnaires at five time points: two during pregnancy and three postpartum. Clinical threshold values (alerts) supported care professionals interpretating the answers, indicating possibly alarming outcomes per domain. Data collection took place from February 2020 till September 2021. Data analysis included missing (pattern) analysis, sum scores, alert rates, and sensitivity analysis.
Results:
In total 1923 questionnaires were collected across the five time points: 816 at T1 (first trimester), 793 at T2 (early third trimester), 125 at T3 (maternity week), 170 at T4 (six weeks postpartum) and 19 at T5 (six months postpartum). Of these, 84% were filled out completely. Missing items per domain ranged from 0 to 13%, with highest missing rates for depression, pain with intercourse and experience with pain relief at birth. No notable missing patterns were found. For the PROM domains, relatively high alert rates were found both in pregnancy and postpartum for incontinence (27%), pain with intercourse (25%), breastfeeding self-efficacy (23%) and mother-child bonding (45%). Regarding PREM domains, highest alert rates were found for birth experience (23%), shared decision making (11%) and discussing pain relief antepartum (41%). Some domains showed little clinical variation: mother role and satisfaction with care.
Conclusions:
The PCB set is a useful tool to assess patient reported outcomes that need to be addressed over the whole course of pregnancy and childbirth. Our results provide opportunities to improve and personalize perinatal care. Furthermore, we could propose several recommendations about methods and timeline measurement based on our findings. This study supports the implementation of the PCB set in clinical practice and thereby advancing transformation towards patient centered, value-based healthcare for pregnancy and childbirth.
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