Women's experiences with using patient-reported outcome and experience measures in routine perinatal care in the Netherlands: a mixed-methods study

Abstract

Objectives: To gain insight into the experiences of women with completing and discussing patient-reported outcome measures (PROM) and patient-reported experience measures (PREM), and tailoring their care based on their outcomes.

Design: A mixed-methods prospective cohort study.

Setting: Seven obstetric care networks in the Netherlands that implemented a set of patient-centred outcome measures for pregnancy and childbirth (PCB set), published by the International Consortium for Health Outcomes Measurement.

Participants: All women, receiving the PROM and PREM questionnaires as part of their routine perinatal care, received an invitation for a survey (n=460) and an interview (n=16). The results of the survey were analysed using descriptive statistics; thematic inductive content analysis was applied on the data from open text answers and the interviews.

Results: More than half of the survey participants (n=255) felt the need to discuss the outcomes of PROM and PREM with their care professionals. The time spent on completing questionnaires and the comprehensiveness of the questions was scored 'good' by most of the survey participants. From the interviews, four main themes were identified: content of the PROM and PREM questionnaires, application of these outcomes in perinatal care, discussing PREM and data capture tool. Important facilitators included awareness of health status, receiving personalised care based on their outcomes and the relevance of discussing PREM 6 months post partum. Barriers were found in insufficient information about the goal of PROM and PREM for individual care, technical problems in data capture tools and discrepancy between the questionnaire topics and the care pathway.

Conclusions: This study showed that women found the PCB set an acceptable and useful instrument for symptom detection and personalised care up until 6 months post partum. This patient evaluation of the PCB set has several implications for practice regarding the questionnaire content, role of care professionals and congruity with care pathways.

Figure 1

Time points for data collection (PROM and PREM) and involvement of different care professionals, according to current practice in the Netherlands. The blue dots indicate the five time points for data collection during pregnancy and postpartum. Above the timeline, the involved care professionals are shown. In this project, the outcomes of the PROMs and PREMs were discussed with an obstetric care professional during all time points. PREM, patient-reported experience measure; PROM, patient-reported outcome measure.

Figure 2

Pregnancy and childbirth set as applied in the Netherlands: domains and moments to measure (adapted from Depla et al 22). The blue dots indicate the five time points for data collection during pregnancy and post partum (see also figure 1). The outcome domains are divided into patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). Below, the number of questions of the total questionnaire (PROM and PREM) per time point is shown.