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Standardized outcome measures for pregnancy and childbirth, an ICHOM proposal

Nijagal MA 1 , Wissig S 2 , Stowell C 2 , Olson E 2 , Amer-Wahlin I 3 , Bonsel G 4 Show all authors , Brooks A 5 , Coleman M 6 , Devi Karalasingam S 7 , Duffy JMN 8 , Flanagan T 9 , Gebhardt S 10 , Greene ME 11 , Groenendaal F 12 , R Jeganathan JR 13 , Kowaliw T 14 , Lamain-de-Ruiter M 12 , Main E 15 , Owens M 16 , Petersen R 17 , Reiss I 6 , Sakala C 18 , Speciale AM 19 , Thompson R 20 , Okunade O 2 , Franx A 21

Affiliations 

  • 1 University of California, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
  • 2 International Consortium for Health Outcomes Measurement, Cambridge, MA, USA
  • 3 Karolinska Institutet, Stockholm, Sweden
  • 4 Erasmus Medical Center, Rotterdam, Netherlands
  • 5 Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA
  • 6 University Hospital Southampton, Hampshire, UK
  • 7 National Clinical Research Centre, Ministry of Health, Kuala Lumpur, Malaysia
  • 8 Balliol College, University of Oxford, Oxford, UK
  • 9 Kaiser Permanente, Richmond, CA, USA
  • 10 Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
  • 11 Massachusetts General Hospital, Boston, MA, USA
  • 12 University Medical Center Utrecht, Utrecht, Netherlands
  • 13 Sultanah Aminah Hospital, Johor Ministry of Health, Johor Bahru, Malaysia
  • 14 South Australian Maternity Reform Association (SAMRA) Inc, Adelaide, Australia
  • 15 California Maternal Quality Care Collaborative, Stanford, CA, USA
  • 16 University of Mississippi Medical Center, Jackson, MS, USA
  • 17 Women and Children's Health Network, North Adelaide, South Australia
  • 18 National Partnership for Women & Families, Washington, D.C., USA
  • 19 American College of Nurse Midwives, Silver Spring, MD, USA
  • 20 The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
  • 21 International Consortium for Health Outcomes Measurement, Cambridge, MA, USA. A.Franx-2@umcutrecht.nl
BMC Health Serv Res, 2018 Dec 11;18(1):953.
PMID: 30537958 DOI: 10.1186/s12913-018-3732-3

Abstract

BACKGROUND: Value-based health care aims to optimize the balance of patient outcomes and health care costs. To improve value in perinatal care using this strategy, standard outcomes must first be defined. The objective of this work was to define a minimum, internationally appropriate set of outcome measures for evaluating and improving perinatal care with a focus on outcomes that matter to women and their families.

METHODS: An interdisciplinary and international Working Group was assembled. Existing literature and current measurement initiatives were reviewed. Serial guided discussions and validation surveys provided consumer input. A series of nine teleconferences, incorporating a modified Delphi process, were held to reach consensus on the proposed Standard Set.

RESULTS: The Working Group selected 24 outcome measures to evaluate care during pregnancy and up to 6 months postpartum. These include clinical outcomes such as maternal and neonatal mortality and morbidity, stillbirth, preterm birth, birth injury and patient-reported outcome measures (PROMs) that assess health-related quality of life (HRQoL), mental health, mother-infant bonding, confidence and success with breastfeeding, incontinence, and satisfaction with care and birth experience. To support analysis of these outcome measures, pertinent baseline characteristics and risk factor metrics were also defined.

CONCLUSIONS: We propose a set of outcome measures for evaluating the care that women and infants receive during pregnancy and the postpartum period. While validation and refinement via pilot implementation projects are needed, we view this as an important initial step towards value-based improvements in care.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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