Unexplored aspects: Improving maternity care through patient-reported outcomes


© Pexels/PNW Production Approximately one-third of women report challenges in their birth experience, along with issues related to healthcare responsiveness and shared decision-making six months postpartum. In the pursuit of comprehensive healthcare quality assessment, traditional clinical indicators often fall short of capturing the nuanced aspects of patient well-being. A retrospective cohort study, conducted by Anouk Klootwijk et al., delves into the transformative potential of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in the realm of pregnancy and childbirth care. By utilizing the International Consortium for Health Outcome Measures (ICHOM) indicator set, the study aims to transform perspectives on quality assessment in maternity care. The study included 645 women and was conducted through an online survey between 2018 and 2019. The focus centred on the women’s experiences six months post-childbirth, capturing PROMs and PREMs at a prominent academic maternity unit in the Netherlands. Regression analysis unravelled associations between these measures, healthcare utilisation, and distinct patient subgroups. Struggles encountered by women giving birth Despite a low 5% dissatisfaction rate with care, the study uncovered suboptimal scores, notably in birth experience (32%) and painful sexual intercourse (42%). Subgroup analyses revealed associations with relevant quality indicators, emphasizing the multifaceted nature of maternity care. Identified subgroups associated with poor scores, such as women in deprived areas and those with a limited social network, had lower birth experience scores. Assisted vaginal delivery was associated with poorer outcomes in health-related quality of life and birth experience. Women with preterm delivery and first-time mothers  had worse scores on multiple PROMs and PREMs compared to women who gave birth at term and multiparous women. For example, preterm birth was linked to insufficient pain relief during labour. This indicates the need for additional attention in terms of pain management in this specific patient group. In addition, about one third of women also reported poor healthcare responsiveness and shared decision-making. Pain during sexual intercourse was conveyed by almost half of all women. There may even be an underestimation in findings due to possible social desirability bias in responses to taboo topics such as incontinency or pain with intercourse. Satisfaction paradox: Suboptimal scores, yet positive feedback Despite these far from optimal scores, women collectively reported good satisfaction with medical care . However, satisfaction with care is more likely to reflect hospitality rather than the actual outcome . Responses are heavily influenced by external factors, including the feeling of personal control, individual expectations, and needs. This highlights the need for a more comprehensive assessment beyond satisfaction scores and indicates the value of more targeted and detailed questionnaires. In conclusion , measuring satisfaction alone is not effective in identifying areas for improving care. PROMs and PREMs offer actionable insights for quality improvement in maternity care and provide a more comprehensive view than traditional clinical outcomes or patient satisfaction scores. The authors emphasize the need for awareness among healthcare professionals regarding persistent pain and sexual health challenges. Training patients and professionals to report, collect, and discuss PROMs and PREMs enables informed shared decision-making.   Paper available at: Patient-reported outcome and experience measures for quality improvement in pregnancy and childbirth care: a retrospective cohort study. BMJ Open Qual. 2023 Mar;12(1):e001922. Full list of authors: Anouk Klootwijk, Pieter Bakx, Arie Franx, Hilmar Bijma, Hiske Ernst-Smelt, Marije Lamain-de Ruiter, Anke Posthumus, Bas van Rijn DOI: 10.1136/bmjoq-2022-001922

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Bridging gaps in neonatal care across Cyprus and Greece: ESCNH Ambassador Dr Vavouraki and Ms Pantelides meet with Cypriot Health Minister Dr Kanaris


A guest article by Dr Eleni Vavouraki and Pani Pantelides It was a trip to remember: Dr Eleni Vavouraki, President of the partner parent organisation Ilitominon and Ambassador for the European Standards of Care for Newborn Health (ESCNH), travelled to Cyprus for a short visit on the island. On 24 November 2023, Dr Vavouraki, together with Pani Pantelides, neonatal-paediatric physiotherapist, had the outstanding opportunity to meet with Dr Popi Kanaris, the Cypriot Minister of Health, to discuss forward-thinking policies in the field of newborn health. Cyprus and Greece are two members of the European Union with long-lasting historical, political, diplomatic, financial, and social ties, which enable them to collaborate and develop simultaneously in various fields. Hence, they also share similar difficulties, challenges, and goals, particularly when it comes to neonatal healthcare. For instance, preterm birth rates in both countries are among the highest in the European Union, yet they have no statistical data to which the number of preterm births can be correlated and lack implementation of wide-ranging family-centred neurodevelopmental care protocols. Additionally, the relatively small population of Cyprus, which constitutes less than 10% of Greece’s total population, presents a unique opportunity to pilot initiatives in a smaller setting. Following successful implementation in Cyprus, these initiatives can then be scaled for broader application, benefiting not only the island but also larger countries like Greece. This overarching goal motivated Dr Vavouraki and Ms Pantelides to arrange this meeting during the first Cyprus-Greece Training Conference for Parents and Health Professionals on “Prematurity and Life After the Neonatal Intensive Care Unit”. The conference was organised by Pani Pantelides’ Developmental Care Centre, under the auspices of the European Foundation for the Care of Newborn Infants (EFCNI) and with the support of the non-governmental volunteer organisation “Thermokoitida Agapis“, which provides support and empowers families affected by prematurity. During a warm, friendly, and fruitful meeting, Minister Kanaris was briefed on the actions of both EFCNI and the ESCNH, which aim to address disparities in neonatal healthcare among the European Union member states. The meeting provided an opportunity for sharing perspectives and information on the current situation across the European Union. The discussion focused mainly on the necessity for national data collection regarding preterm births and the future health conditions of these infants since systematic structured data collection is often neither organised at obstetrical or neonatal units nor coordinated nationally. As it is noted in the ESCNH, “effective reporting would reach all target groups, provide answers to a wide range of questions and help develop prevention strategies”. Minister Kanaris, Dr Vavouraki and Ms Pantelides agreed that a national guideline on infrastructure for data collection and analysis, data entry, and the use of (inter-) nationally agreed on datasets is the first and most significant step towards understanding and improving health outcomes in both Cyprus and Greece. © Eleni Vavouraki

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Manual ventilation in neonates and preterm infants: An expert interview


Whenever manual ventilation in the delivery room (DR) or in the neonatal intensive care unit (NICU) is necessary, caregivers face a demanding task. They have to avoid over- and underventilation as well as keep track of multiple tasks being performed simultaneously, to name just some of the particular challenges. Positive pressure ventilation (PPV) is the standard procedure for manual ventilation in neonates and preterm infants – but its accurate application depends largely on the experience and skill of the caregiver who controls it. We asked two experts in paediatric intensive care to elaborate on the challenges for caregivers, possible short- and long-term consequences for the preterm infants, and on their experience working with a respiratory function monitor. Will these monitors contribute data leading to a better determination of key respiratory parameters in PPV of neonates? Watch PD Dr. med Martin Stocker’s and ap. Prof. PD DDr. Michael Wagner’s stance on these questions:

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