Department of Obstetrics and Gynecology, OLVG, Amsterdam, The Netherlands.
Department of Quality and Improvement, St. Antonius Hospital, Utrecht, /Nieuwegein, The Netherlands.
J Eval Clin Pract. 2020 Feb;26(1):101-108. doi: 10.1111/jep.13208. Epub 2019 Jun 13.
RATIONALE, AIMS, AND OBJECTIVES: We strive to maximize outcomes that are relevant to the women who deliver in our hospital. We demonstrate a practical method of using value-based health care (VBHC) concepts to analyse how care can be improved.
Using International Consortium of Health Outcome Measurements (ICHOM) set, a practical outcome set was constructed for women who go into spontaneous labour at term of a singleton in cephalic presentation and used for benchmarking. We included data on interventions that are major drivers of outcomes. Data from two hospitals in Amsterdam and for The Netherlands for 2011 to 2015 were collected.
Benchmarking of readily available data helped identify a number of statistically significant and clinically relevant differences in obstetric outcomes. Caesarean section rate was significantly different at 13.7% in hospital 2 compared with 11.5% in hospital 1 with similar neonatal outcomes. Third and fourth degree tearing rates were significantly higher for hospital 1 at 5.5% compared with 3.6% for hospital 2 and the national average of 3.5%. On the basis of the guidelines, literature, and discussion, initiatives on how to improve these outcomes were then identified. These include caesarean section audit and guidelines regarding caesarean section decision making. In order to reduce the rate of third and fourth degree tearing, routine episiotomy on vaginal operative deliveries was introduced, and a training programme was set up to make care providers more aware of risk factors and potential preventive measures.
Defining, measuring, and comparing relevant outcomes enable care providers to identify improvements. Collection and comparison of readily available data can provide insights in where care can be improved. Insights from literature and comparison of care practices and processes can lead to how care can be improved. Continuous monitoring of outcomes and expanding the set of outcomes that is readily available are key in the process towards value-based care provision.
背景、目的和目标：我们努力使与在我院分娩的女性相关的结果最大化。我们展示了一种实用的方法，即使用基于价值的医疗保健（VBHC）概念来分析如何改进护理。
使用国际健康结果测量联合会（ICHOM）集，为在足月自然分娩的头位单胎女性构建了一个实用的结果集，并用于基准测试。我们纳入了对结果有重大影响的干预措施的数据。收集了阿姆斯特丹的两家医院和荷兰在 2011 年至 2015 年的数据。
现成数据的基准测试有助于确定在产科结果方面存在许多具有统计学意义和临床意义的差异。医院 2 的剖宫产率为 13.7%，显著高于医院 1 的 11.5%，而新生儿结局相似。医院 1 的第三和第四度撕裂率明显高于医院 2 的 5.5%，也高于全国平均水平 3.5%。根据指南、文献和讨论，确定了如何改善这些结果的举措。这些举措包括剖宫产审核和剖宫产决策指南。为了降低第三和第四度撕裂的发生率，在阴道手术分娩时常规行会阴切开术，并制定了培训计划，使护理人员更加了解风险因素和潜在的预防措施。
定义、衡量和比较相关结果使护理人员能够识别改进的机会。收集和比较现成的数据可以洞察护理可以改进的地方。从文献中获取见解以及比较护理实践和流程可以为如何改进护理提供思路。持续监测结果并扩大现成结果集是向基于价值的医疗保健提供方式发展的关键。
