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Batinelli L, Thaels E, Leister N, McCourt C, Bonciani M, Rocca-Ihenacho L. What are the strategies for implementing primary care models in maternity? A systematic review on midwifery units. BMC Pregnancy Childbirth 2022; 22:123. [PMID: 35152880 PMCID: PMC8842978 DOI: 10.1186/s12884-022-04410-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/13/2021] [Indexed: 01/17/2023] Open
Abstract
Background Midwifery Units (MUs) are associated with optimal perinatal outcomes, improved service users’ and professionals’ satisfaction as well as being the most cost-effective option. However, they still do not represent the mainstream option of maternity care in many countries. Understanding effective strategies to integrate this model of care into maternity services could support and inform the MU implementation process that many countries and regions still need to approach. Methods A systematic search and screening of qualitative and quantitative research about implementation of new MUs was conducted (Prospero protocol reference: CRD42019141443) using PRISMA guidelines. Included articles were appraised using the CASP checklist. A meta-synthesis approach to analysis was used. No exclusion criteria for time or context were applied to ensure inclusion of different implementation attempts even under different historical and social circumstances. A sensitivity analysis was conducted to reflect the major contribution of higher quality studies. Results From 1037 initial citations, twelve studies were identified for inclusion in this review after a screening process. The synthesis highlighted two broad categories: implementation readiness and strategies used. The first included aspects related to cultural, organisational and professional levels of the local context whilst the latter synthesised the main actions and key points identified in the included studies when implementing MUs. A logic model was created to synthesise and visually present the findings. Conclusions The studies selected were from a range of settings and time periods and used varying strategies. Nonetheless, consistencies were found across different implementation processes. These findings can be used in the systematic scaling up of MUs and can help in addressing barriers at system, service and individual levels. All three levels need to be addressed when implementing this model of care.
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Murphy MSQ, Fell DB, Sprague AE, Corsi DJ, Dougan S, Dunn SI, Holmberg V, Huang T, Johnson M, Kotuba M. Data Resource Profile: Better Outcomes Registry & Network (BORN) Ontario. Int J Epidemiol 2021; 50:1416-1417h. [PMID: 34097034 PMCID: PMC8580270 DOI: 10.1093/ije/dyab033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- Malia S Q Murphy
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Deshayne B Fell
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Canada
| | - Ann E Sprague
- BORN Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Daniel J Corsi
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Canada
| | - Shelley Dougan
- BORN Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Sandra I Dunn
- BORN Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Vivian Holmberg
- BORN Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Tianhua Huang
- BORN Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Moya Johnson
- BORN Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Michael Kotuba
- BORN Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
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Reszel J, Weiss D, Darling EK, Sidney D, Van Wagner V, Soderstrom B, Rogers J, Holmberg V, Peterson WE, Khan BM, Walker MC, Sprague AE. Client Experience with the Ontario Birth Center Demonstration Project. J Midwifery Womens Health 2020; 66:174-184. [PMID: 33336882 PMCID: PMC8247041 DOI: 10.1111/jmwh.13164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/18/2020] [Accepted: 08/02/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In 2014, 2 new freestanding midwifery-led birth centers opened in Ontario, Canada. As one part of a larger mixed-methods evaluation of the first year of operations of the centers, our primary objective was to compare the experiences of women receiving midwifery care who intended to give birth at the new birth centers with those intending to give birth at home or in hospital. METHODS We conducted a cross-sectional survey of women cared for by midwives with admitting privileges at one of the 2 birth centers. Consenting women received the survey 3 to 6 weeks after their due date. We stratified the analysis by intended place of birth at the beginning of labor, regardless of where the actual birth occurred. One composite indicator was created (Composite Satisfaction Score, out of 20), and statistical significance (P < .05) was assessed using one-way analysis of variance. Responses to the open-ended questions were reviewed and grouped into broader categories. RESULTS In total, 382 women completed the survey (response rate 54.6%). Half intended to give birth at a birth center (n = 191). There was a significant difference on the Composite Satisfaction Scores between the birth center (19.4), home (19.5), and hospital (18.9) groups (P < .001). Among women who intended to give birth in a birth center, scores were higher in the women admitted to the birth center compared with those who were not (P = .037). Overall, women giving birth at a birth center were satisfied with the learners present at their birth, the accessibility of the centers, and the physical amenities, and they had suggestions for minor improvements. DISCUSSION We found positive experiences and high satisfaction among women receiving midwifery care, regardless of intended place of birth. Women admitted to the birth centers had positive experiences with these new centers; however, future research should be planned to reassess and further understand women's experiences.
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Affiliation(s)
- Jessica Reszel
- Better Outcomes Registry & Network (BORN) Ontario, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada.,CHEO Research Institute, CHEO, Ottawa, Ontario, Canada
| | - Deborah Weiss
- Better Outcomes Registry & Network (BORN) Ontario, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Elizabeth K Darling
- McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Dana Sidney
- Better Outcomes Registry & Network (BORN) Ontario, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Vicki Van Wagner
- Midwifery Education Program, Ryerson University, Toronto, Ontario, Canada
| | - Bobbi Soderstrom
- Midwifery Education Program, Ryerson University, Toronto, Ontario, Canada.,Association of Ontario Midwives (AOM), Toronto, Ontario, Canada
| | - Judy Rogers
- Midwifery Education Program, Ryerson University, Toronto, Ontario, Canada
| | - Vivian Holmberg
- Better Outcomes Registry & Network (BORN) Ontario, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Wendy E Peterson
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Bushra M Khan
- Better Outcomes Registry & Network (BORN) Ontario, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Mark C Walker
- Better Outcomes Registry & Network (BORN) Ontario, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ann E Sprague
- Better Outcomes Registry & Network (BORN) Ontario, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada.,CHEO Research Institute, CHEO, Ottawa, Ontario, Canada
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Symon A, Shinwell S. Qualitative evaluation of an innovative midwifery continuity scheme: Lessons from using a quality care framework. Birth 2020; 47:378-388. [PMID: 33263206 DOI: 10.1111/birt.12512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Innovative midwifery schemes must be robustly evaluated to establish whether they should be modified or can be replicated. Assessing quality of care can help to ascertain a scheme's acceptability and effectiveness. We used an established quality care framework as a benchmark in our qualitative evaluation of a combined continuity of caregiver and planned home birth scheme in Scotland. METHODS Qualitative evaluation of stakeholder perceptions using the Quality Maternal and Newborn Care Framework was the basis for six focus groups and two one-to-one interviews with stakeholders (new mothers, partners, midwives). A thematic analytical approach was used. RESULTS The qualitative evaluation found universal approval among participants. Flexible working patterns helped to nurture positive relationships, and information and support were highly valued. The principal themes-Organization of Care/Work Culture; Information and Support; Relationships-were strongly inter-related. They shared several subthemes, notably continuity of caregiver, flexible family-centered care, and the benefits of being at home. Flexibility and mutual respect helped women to express autonomy and develop agency. Women related their birth experiences to friends, family, and colleagues, thereby helping to normalize home birth. CONCLUSIONS This qualitative evaluation of an innovative scheme used an established quality framework as a benchmark against which to assess stakeholder experiences. This approach helped to identify the critical codependence of factors involved in care delivery, which in turn helps to identify lessons for others considering similar schemes. Although our evaluation relates to one specific scheme, identifying the scheme's critical quality care aspects may assist others when planning similar schemes.
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Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Shona Shinwell
- Maternity Services, Ninewells Hospital, NHS Tayside, Dundee, UK
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Dunn S, Lanes A, Sprague AE, Fell DB, Weiss D, Reszel J, Taljaard M, Darling EK, Graham ID, Grimshaw JM, Harrold J, Smith GN, Peterson W, Walker M. Data accuracy in the Ontario birth Registry: a chart re-abstraction study. BMC Health Serv Res 2019; 19:1001. [PMID: 31881960 PMCID: PMC6935171 DOI: 10.1186/s12913-019-4825-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 12/09/2019] [Indexed: 11/18/2022] Open
Abstract
Background Ontario’s birth Registry (BORN) was established in 2009 to collect, interpret, and share critical data about pregnancy, birth and the early childhood period to facilitate and improve the provision of healthcare. Since the use of routinely-collected health data has been prioritized internationally by governments and funding agencies to improve patient care, support health system planning, and facilitate epidemiological surveillance and research, high quality data is essential. The purpose of this study was to verify the accuracy of a selection of data elements that are entered in the Registry. Methods Data quality was assessed by comparing data re-abstracted from patient records to data entered into the Ontario birth Registry. A purposive sample of 10 hospitals representative of hospitals in Ontario based on level of care, birth volume and geography was selected and a random sample of 100 linked mother and newborn charts were audited for each site. Data for 29 data elements were compared to the corresponding data entered in the Ontario birth Registry using percent agreement, kappa statistics for categorical data elements and intra-class correlation coefficients (ICCs) for continuous data elements. Results Agreement ranged from 56.9 to 99.8%, but 76% of the data elements (22 of 29) had greater than 90% agreement. There was almost perfect (kappa 0.81–0.99) or substantial (kappa 0.61–0.80) agreement for 12 of the categorical elements. Six elements showed fair-to-moderate agreement (kappa <0.60). We found moderate-to-excellent agreement for four continuous data elements (ICC >0.50). Conclusion Overall, the data elements we evaluated in the birth Registry were found to have good agreement with data from the patients’ charts. Data elements that showed moderate kappa or low ICC require further investigation.
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Affiliation(s)
- Sandra Dunn
- Better Outcomes Registry & Network , Ottawa, Ontario, Canada. .,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada. .,University of Ottawa, Ottawa, Ontario, Canada.
| | - Andrea Lanes
- Better Outcomes Registry & Network , Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Ann E Sprague
- Better Outcomes Registry & Network , Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Deshayne B Fell
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Deborah Weiss
- Better Outcomes Registry & Network , Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Jessica Reszel
- Better Outcomes Registry & Network , Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Monica Taljaard
- University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Ian D Graham
- University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jeremy M Grimshaw
- University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - JoAnn Harrold
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Graeme N Smith
- Kingston General Hospital and Queen's University, Kingston, Ontario, Canada
| | | | - Mark Walker
- Better Outcomes Registry & Network , Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,The Ottawa Hospital, Ottawa, Ontario, Canada
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