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Value-based health care in obstetrics.

Kim Van Den Berg1, Lea Magdalena Dijksman2, Samyra Hermione Jessica Keus3

  • 1Department of Obstetrics and Gynecology, OLVG, Amsterdam, The Netherlands.

Journal of Evaluation in Clinical Practice
|June 15, 2019
PubMed
Summary

Value-based healthcare analysis using International Consortium of Health Outcome Measurements (ICHOM) identified significant differences in obstetric outcomes between hospitals. Benchmarking care practices led to targeted improvements for better maternal and neonatal health.

Keywords:
Robson-1VBHCcaesarean sectionoutcomesquality improvementvalue-based health care

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Area of Science:

  • Obstetrics and Gynecology
  • Health Services Research
  • Value-Based Healthcare

Background:

  • Maximizing patient-relevant outcomes is crucial in maternity care.
  • Value-based healthcare (VBHC) offers a framework for analyzing and improving care quality.
  • Standardized outcome measurement is essential for benchmarking and identifying variations in care.

Purpose of the Study:

  • To demonstrate a practical method for applying VBHC concepts to analyze obstetric care.
  • To benchmark obstetric outcomes using a standardized set of measures.
  • To identify areas for improvement in maternity care delivery.

Main Methods:

  • Utilized the International Consortium of Health Outcome Measurements (ICHOM) standard set for outcome measurement.
  • Collected and analyzed data on interventions and outcomes for women in spontaneous labor (singleton, cephalic presentation) from two Amsterdam hospitals and national data (2011-2015).
  • Compared key obstetric outcomes such as cesarean section rates and severe perineal tearing rates.

Main Results:

  • Significant variations in cesarean section rates (11.5% vs. 13.7%) and third/fourth-degree tearing rates (5.5% vs. 3.6%) were identified between hospitals, with similar neonatal outcomes.
  • Benchmarking highlighted statistically significant and clinically relevant differences in care quality.
  • Identified specific areas for improvement, including cesarean section decision-making and management of perineal trauma.

Conclusions:

  • Defining, measuring, and comparing relevant outcomes are key to identifying and implementing improvements in obstetric care.
  • Readily available data, when collected and compared, provides valuable insights into care variations.
  • Continuous outcome monitoring and expansion of outcome sets are vital for advancing value-based maternity care.