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. 2018 May 21;18(1):374.
doi: 10.1186/s12913-018-3179-6.

He Tamariki Kokoti Tau-Tackling Preterm: a data-linkage methodology to explore the clinical care pathway in preterm deliveries

Sara Filoche  1 , Fiona Cram  2 , Angela Beard  3 , Dalice Sim  4 , Stacie Geller  5 , Liza Edmonds  6 , Bridget Robson  7 , Beverley Lawton  8
Affiliations

He Tamariki Kokoti Tau-Tackling Preterm: a data-linkage methodology to explore the clinical care pathway in preterm deliveries

Sara Filoche et al. BMC Health Serv Res. .

Abstract

Background: Significant health inequities exist around maternal and infant health for Māori, the indigenous people of Aotearoa New Zealand - and in particular around a premature (preterm) delivery. Māori babies are more likely to be born preterm (8.1%, compared to an overall rate of 7.4%) and they are more likely to have a preterm death. An essential part of redressing these disparities is to examine the clinical care pathway and outcomes associated with preterm deliveries. This paper describes a protocol utilising national and local health collections to enable such a study.

Design: This is a retrospective cohort study comprising 5 years data pertaining to preterm deliveries from 2010 to 2014. These data are generated from linked national administrative and local health information collections to explore a range of neonatal outcomes and infant mortality in relation to the antenatal care pathway and known risk factors for preterm delivery. This study is being conducted within a Kaupapa Māori paradigm that dismisses victim blaming and seeks to intervene at structural levels to improve the health and wellbeing of Māori whānau (family).

Significance of the study: Our data-linkage methodology optimises the utility of New Zealand health collections to address a significant health issue. Our findings will fill the information gaps around the burden of preterm delivery by quantifying the incidence of preterm delivery and adverse neonatal and infant outcomes in Aotearoa New Zealand. It will explore access to evidenced based care including use of steroids before birth, and appropriate place of delivery. The results from this study will inform maternity care services to improve management of preterm deliveries - both locally and internationally. This in turn will improve the preterm sequela by reducing the long-term health burden and health inequities.

Keywords: Clinical care pathway; Data linking; Equity; Health disparities; Indigenous health; Kaupapa Māori; Maternity care services; Preterm delivery.

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Conflict of interest statement

Ethics approval and consent to participate

Ethics approval is needed for this study as we are using un-encrypted NHI numbers (to enable accurate individual level matching from the mother to fetal/neonatal outcomes). Ethics approval to utilise data from the national collections is obtained through the Health and Disability Ethics Committee (HDEC). Our study has been granted national ethical approval by the New Zealand Northern B Ethics Committee (Ref 16/NTB/186).

Local ethics approval is needed for the in-depth study in the 5 DHBs to obtain and use local hospital data. Each DHB has its own process which also comprises an application to local Māori research committees to help ensure that the research is tika (ethical) and is of benefit to Māori. Face-to-face consultation with key stakeholders is carried out at each DHB prior to application. The application to grant permission to obtain and use local hospital data is discussed at respective committees such as the Women’s Health Governance Group, and it is usual for a clinician to be named as a local investigator, this ensures that the study meets local requirements and to provide appropriate interpretation of the results (i.e. are informed by local knowledge). Results will not be published without prior knowledge of the relevant stakeholders.

Competing interests

The authors declare they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Overview of study protocol outlining the main data collation steps and exclusion criteria for each Primary Outcome AN1 (Antenatal booking). NICU (Neonatal Intensive Care Unit)
See this image and copyright information in PMC

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