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. 2018 Nov;125(12):1612-1618.
doi: 10.1111/1471-0528.15282. Epub 2018 Jun 14.

Developing a set of consensus indicators to support maternity service quality improvement: using Core Outcome Set methodology including a Delphi process

K J Bunch  1 , B Allin  1 , M Jolly  2 , T Hardie  2 , M Knight  1
Affiliations

Developing a set of consensus indicators to support maternity service quality improvement: using Core Outcome Set methodology including a Delphi process

K J Bunch et al. BJOG. 2018 Nov.

Abstract

Objective: To develop a core metric set to monitor the quality of maternity care.

Design: Delphi process followed by a face-to-face consensus meeting.

Setting: English maternity units.

Population: Three representative expert panels: service designers, providers and users.

Main outcome measures: Maternity care metrics judged important by participants.

Methods: Participants were asked to complete a two-phase Delphi process, scoring metrics from existing local maternity dashboards. A consensus meeting discussed the results and re-scored the metrics.

Results: In all, 125 distinct metrics across six domains were identified from existing dashboards. Following the consensus meeting, 14 metrics met the inclusion criteria for the final core set: smoking rate at booking; rate of birth without intervention; caesarean section delivery rate in Robson group 1 women; caesarean section delivery rate in Robson group 2 women; caesarean section delivery rate in Robson group 5 women; third- and fourth-degree tear rate among women delivering vaginally; rate of postpartum haemorrhage of ≥1500 ml; rate of successful vaginal birth after a single previous caesarean section; smoking rate at delivery; proportion of babies born at term with an Apgar score <7 at 5 minutes; proportion of babies born at term admitted to the neonatal intensive care unit; proportion of babies readmitted to hospital at <30 days of age; breastfeeding initiation rate; and breastfeeding rate at 6-8 weeks.

Conclusions: Core outcome set methodology can be used to incorporate the views of key stakeholders in developing a core metric set to monitor the quality of care in maternity units, thus enabling improvement.

Tweetable abstract: Achieving consensus on core metrics for monitoring the quality of maternity care.

Keywords: Core outcome set; Delphi process; dashboard; indicator; maternity service; quality improvement; quality of care.

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