Depla Anne L, Ernst-Smelt Hiske E, Poels Marjolein, Crombag Neeltje M, Franx Arie, Bekker Mireille N
Department of Obstetrics and Gynecology, Wilhelmina Children's Hospital University Medical Center Utrecht Utrecht the Netherlands.
Department of Obstetrics and Gynecology, Erasmus MC - Sophia Children's Hospital University Medical Center Rotterdam Rotterdam the Netherlands.
Health Sci Rep. 2020 Jun 26;3(3):e168. doi: 10.1002/hsr2.168. eCollection 2020 Sep.
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.
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.
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.
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.
患者报告的结局和体验指标（PROM和PREM）有助于共同决策，并有可能改善医疗质量。然而，它们在围产期护理中的应用仍然有限。国际健康结局测量协会（ICHOM）制定了一套妊娠与分娩（PCB）结局指标，包括PROM和PREM问卷。我们从女性和专业人员的角度研究了在荷兰围产期护理中使用这些PROM/PREM的可行性。
初级保健和医院护理中的患者及专业人员参与了研究。在PCB指标集的PROM/PREM收集的五个时间点之一接受护理的女性（孕期2个时间点，产后3个时间点）通过电子邮件收到问卷，并在下次常规就诊时与产科专业人员讨论答案。记录依从性。在讨论PROM/PREM之后，通过对女性和专业人员进行单独调查来评估其可用性和体验。
在26名被邀请的女性中，21名完成并讨论了她们的PROM/PREM问卷。问卷平均完成率为97%。报告的平均问卷完成时间为10分钟；大多数女性（90%）表示这是可以接受的。女性更喜欢以数字方式完成问卷，并与产科专业人员讨论答案，而不是其他护理专业人员，产后6个月时也是如此。超过一半的女性同意PROM/PREM有助于共同决策（58%）、提出问题的能力（60%）以及患者与临床医生的关系（52%）。六名专业人员参与了研究：两名产科医生、两名临床助产士和两名社区助产士。除了产后6个月外，大多数专业人员都有足够的时间讨论答案。他们知道要讨论哪些项目，但并不总是觉得有责任采取行动。专业人员同意PROM/PREM有助于症状检测和个性化护理。
患者和产科专业人员认为PCB指标集是用于PROM/PREM评估的可行工具，具有良好的依从性、可接受性和可用性。成功实施的重要决定因素是配备完善的信息通信技术工具、关于专业人员职责以及如何讨论或处理结局的协议。
