Implementation of a standard outcome set in perinatal care: a qualitative analysis of barriers and facilitators from all stakeholder perspectives

Anne L Depla,Arie Franx,Neeltje M Crombag,Mireille N Bekker

doi:10.1186/s12913-021-06121-z

Abstract

BackgroundTo improve their quality, healthcare systems are increasingly focused on value delivered to patients. For perinatal care, the International Consortium for Health Outcomes Measurement (ICHOM) proposed a patient-centred outcome set with both clinical and patient-reported measures for pregnancy and childbirth (PCB set). This study aimed to identify factors that affect the implementation of the PCB set at the pre-implementation stage, using the consolidated framework for implementation research (CFIR).MethodsIn this qualitative study, we conducted semi-structured interviews amongst a purposive sample of key stakeholders within an obstetric care network (OCN): 1) patients, 2) perinatal care professionals involved in the full cycle of perinatal care, and 3) policy makers, including hospital managers, administrative staff and health care insurers. While the CFIR guided data capture and structuring, thematic analysis revealed overarching themes that best reflected the barriers and facilitators from different stakeholder perspectives. Within these overarching themes, the CFIR constructs were maintained.ResultsInterviews were conducted with 6 patients, 16 professionals and 5 policy makers. Thematic analysis supported by the CFIR framework identified four main themes: the instrument and its implementation process, use in individual patient care, use in quality improvement, and the context of the OCN. Important barriers included professional workload, data reliability, and interprofessional and interorganizational collaboration. Potential facilitators were the PCB set’s direct value in individual care, interprofessional feedback and education, and aligning with existing systems. Prominent variations between stakeholder groups included the expected patient burden, the level of use, transparency of outcomes and the degree of integrated care.ConclusionsThis study clarified critical factors that affect successful implementation of the PCB set in perinatal care. Practice recommendations, suggested at multiple levels, can enable structural patient-centred care improvement and may unite stakeholders towards integrated birth care.

Highlights

To improve their quality, healthcare systems are increasingly focused on value delivered to patients
Analysis and interpretation were guided by the Consolidated Framework for Implementation Research (CFIR), a framework of standardized constructs developed by meta-analysis of theory-based models from several disciplines and proven to support the implementation process [20]
Analysis Data analysis started directly after the first interview, using a combined deductive and inductive approach along the Results At 27 interviews, saturation was reached: 6 with patients, 16 with care professionals and 5 with policy makers involved in the obstetric care network (OCN) (Table 2)

Summary

Introduction

Healthcare systems are increasingly focused on value delivered to patients. After the era of evidence based medicine, healthcare stakeholders are aligning their goals in “learning health systems” that continuously measure and improve the value of care from the patients’ perspective [2,3,4]. Numerous quality indicators are available, as pregnancy and childbirth are worldwide drivers of morbidity and costs, and large practice variation exists. Until now these indicators mainly focused on structure and process measures, such as prenatal care utilization or caesarean section rate, and to a lesser extent on clinical outcomes like postpartum haemorrhage. They often lack an improvement incentive for clinicians [10]

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Discussion

Conclusion