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. 2023 Apr 1;33(2):342-348.
doi: 10.1093/eurpub/ckad013.

Impact of the EURO-PERISTAT Reports on obstetric management: a difference-in-regression-discontinuity analysis

Leonie A Daalderop  1 , Jasper V Been  1   2   3 , Eric A P Steegers  1 , Loes C M Bertens  1
Affiliations

Impact of the EURO-PERISTAT Reports on obstetric management: a difference-in-regression-discontinuity analysis

Leonie A Daalderop et al. Eur J Public Health. .

Abstract

Background: Population health monitoring, such as perinatal mortality and morbidity rankings published by the European Perinatal Health (EURO-PERISTAT) reports may influence obstetric care providers' decision-making and professional behaviour. We investigated short-term changes in the obstetric management of singleton term deliveries in the Netherlands following publication of the EURO-PERISTAT reports in 2003, 2008 and 2013.

Methods: We used a quasi-experimental difference-in-regression-discontinuity approach. National perinatal registry data (2001-15) was used to compare obstetric management at delivery in four time windows (1, 2, 3 and 5 months) surrounding publication of each EURO-PERISTAT report.

Results: The 2003 EURO-PERISTAT report was associated with higher relative risks (RRs) for an assisted vaginal delivery across all time windows [RR (95% CI): 1 month: 1.23 (1.05-1.45), 2 months: 1.15 (1.02-1.30), 3 months: 1.21 (1.09-1.33) and 5 months: 1.21 (1.11-1.31)]. The 2008 report was associated with lower RRs for an assisted vaginal delivery at the 3- and 5-month time windows [0.86 (0.77-0.96) and 0.88 (0.81-0.96)]. Publication of the 2013 report was associated with higher RRs for a planned caesarean section across all time windows [1 month: 1.23 (1.00-1.52), 2 months: 1.26 (1.09-1.45), 3 months: 1.26 (1.12-1.42) and 5 months: 1.19(1.09-1.31)] and lower RRs for an assisted vaginal delivery at the 2-, 3- and 5-month time windows [0.85 (0.73-0.98), 0.83 (0.74-0.94) and 0.88 (0.80-0.97)].

Conclusions: This study showed that quasi-experimental study designs, such as the difference-in-regression-discontinuity approach, are useful to unravel the impact of population health monitoring on decision-making and professional behaviour of healthcare providers. A better understanding of the contribution of health monitoring to the behaviour of healthcare providers can help guide improvements within the (perinatal) healthcare chain.

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Figures

Figure 1
Figure 1
Directed acyclic graph. A directed acyclic graph (DAG) can be used to map a priori assumptions surrounding a causal question of interest. The idea of the regression discontinuity (RD) design is to compare deliveries close to the threshold (EURO-PERISTAT publication). Those with a date of birth just above the threshold should be comparable to the ones with a date of birth just below the threshold. Important is that none of the other variables in the model should exhibit any discontinuity around the publication of the EURO-PERISTAT reports. In addition, only locally valid effects of the EURO-PERISTAT reports are obtained, because deliveries further away from the threshold (i.e. time of publication), will cease to be really comparable. So, in this study date of birth determines whether a delivery is exposed or not to the information published in the EURO-PERISTAT reports. Information in the EURO-PERISTAT reports may result in alterations in obstetric management at delivery, which may affect perinatal health outcomes. To provide a valid RD analysis it is important that additional explanatory variables (e.g. risk factor in the DAG) do not suddenly alter around the threshold, because we will compare deliveries slightly left and right of the threshold. We therefore need to make sure that these variables would confound not our estimate. To do so, we accounted for variations in maternal characteristics that may cause heterogeneity in the estimated impact of the EURO-PERISTAT reports, by adjusting for maternal age, parity, ethnicity and neighbourhood SES
Figure 2
Figure 2
Flowchart of study sample
See this image and copyright information in PMC

References

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