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A feasibility study of implementing a patient-centered outcome set for pregnancy and childbirth
Anne L Depla1, Hiske E Ernst-Smelt2, Marjolein Poels1
1Department of Obstetrics and Gynecology, Wilhelmina Children's Hospital University Medical Center Utrecht Utrecht the Netherlands.
Insights
Patient-reported outcome and experience measures (PROMs/PREMs) are feasible in Dutch perinatal care. High compliance and acceptability were found, supporting shared decision-making and personalized care.
Area of Science:
- Perinatal healthcare quality improvement
- Patient-centered outcomes research
Background:
- Patient-reported outcome and experience measures (PROMs/PREMs) can enhance shared decision-making and healthcare quality.
- Adoption of PROMs/PREMs in perinatal care remains limited.
- The International Consortium for Health Outcomes Measurement (ICHOM) developed a Pregnancy and Childbirth (PCB) outcome set.
Purpose of the Study:
- To assess the feasibility of implementing the ICHOM Pregnancy and Childbirth (PCB) outcome set in Dutch perinatal care.
- To evaluate the perspectives of both women and healthcare professionals on using PROMs/PREMs.
Main Methods:
- A feasibility study involving women and professionals in primary and hospital perinatal care.
- Women completed PCB set questionnaires at five timepoints (2 during pregnancy, 3 postpartum) and discussed results with their obstetric professional.
- Usability and experience were assessed via surveys among women and professionals.
Main Results:
- High questionnaire completion rate (97%) and acceptability (90% found 10 minutes acceptable).
- Women preferred digital completion and discussion with obstetric professionals, finding PROMs/PREMs supported shared decision-making (58%), issue raising (60%), and the patient-clinician relationship (52%).
- Professionals found time sufficient except postpartum, identified PROMs/PREMs supported symptom detection and personalized care, but noted ambiguity in responsibility for acting on outcomes.
Conclusions:
- The ICHOM PCB set is considered a feasible instrument for PROM/PREM assessment in Dutch perinatal care, demonstrating good compliance, acceptability, and usability.
- Successful implementation hinges on robust ICT tools, clear professional responsibilities, and defined protocols for discussing and acting upon outcomes.
Background And Aims:
Patient-reported outcome and experience measures (PROM and PREM) can facilitate shared decision making and hold potential to improve healthcare quality. However, their adoption in perinatal care is still limited. The International Consortium for Health Outcomes Measurement (ICHOM) developed a Pregnancy and Childbirth (PCB) outcome set, including PROM and PREM questionnaires. We studied the feasibility to use these PROMs/PREMs in Dutch perinatal care, addressing both women's and professionals' perspective.
Methods:
Patients and professionals in primary and hospital care participated. Women under care at one of five timepoints for PROM/PREM collection of the PCB set (2 during pregnancy, 3 postpartum) were e-mailed a questionnaire and discussed their answers with their obstetric professional the next regular visit. Compliance was recorded. After discussing the PROMs/PREMs, usability and experience were assessed with separate surveys amongst women and professionals.
Results:
Of 26 women approached, 21 completed and discussed their PROM/PREM questionnaire. Mean questionnaire completion rate was 97%. Average reported time completing the questionnaires was 10 minutes; most women (90%) stated this was acceptable. Women preferred completing questionnaires digitally and discuss their answers with an obstetric professional rather than other care professionals, also 6 months postpartum. Over half of women agreed PROMs/PREMs supported shared decision making (58%), ability to raise issues (60%), and patient-clinician relationship (52%). Six professionals participated: two obstetricians, two clinical midwives, and two community midwives. Most professionals experienced sufficient time to discuss the responses, except at 6 months postpartum. They knew what items to discuss but did not always feel responsible to act upon them. Professionals agreed PROMs/PREMs supported symptom detection and personalized care.
Conclusions:
Patients and obstetric professionals consider the PCB set a feasible instrument for PROM/PREM assessment, with good compliance, acceptability and usability. Important determinants of successful implementation are a well-equipped ICT-tool, agreements regarding professionals' responsibilities and how outcomes are discussed or acted upon.
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