Article type
Year
Abstract
Background: Systematic and explicit methods to combine scientific evidence with professional consensus for assessing the appropriateness of care have been developed to a limited extent. Obstetric care during childbirth is suitable to further develop such methods because it is both a field with a high production of systematic reviews (SRs) and where many indicators currently used may be questionable or may need to be reassessed/reexamined.
Objectives: To generate a set of indicators to assess the appropriateness of obstetric care related to childbirth based on evidence from SRs.
Methods: We reviewed all the SRs from the Cochrane Pregnancy and Childbirth Group (Cochrane Library Issue 3, 2009) and searched for Clinical Evidence and main guidelines to identify further SRs. We selcted interventions supported by high quality evidence (of a benefit or harm) and from which a strong recommendation could be obtained using GRADE methodoloy. A group of experts partipated in the recommendation generation and provided feedback on the indicatorsá content validity and reliability.
Results: We identified 303 SRs. After excluding SRs about non-acute care, not delivered in hospital or without clear evidence (either in favour or against), we select 48 SRs that generated 21 strong recommendations based on high quality evidence. The group of experts considered valid and reliable a total of 18 quality indicators: eight referred to prepartum care, eight referred to delivery, one referred to postpartum and one referred to incomplete miscarriage. These quality indicators are currently being tested for their validity, reliability and feasibility in a pilot study.
Conclusions: It is possible and feasible to develop evidence-based quality indicators to measure the appropriateness of care in Obstetrics. High-quality SRs that explicitly express support for or against an intervention are reliable and accessible tools for generating indicators of quality of care, once considered to be the nuances of clinical practice, and help to make the indicators coherent.
Objectives: To generate a set of indicators to assess the appropriateness of obstetric care related to childbirth based on evidence from SRs.
Methods: We reviewed all the SRs from the Cochrane Pregnancy and Childbirth Group (Cochrane Library Issue 3, 2009) and searched for Clinical Evidence and main guidelines to identify further SRs. We selcted interventions supported by high quality evidence (of a benefit or harm) and from which a strong recommendation could be obtained using GRADE methodoloy. A group of experts partipated in the recommendation generation and provided feedback on the indicatorsá content validity and reliability.
Results: We identified 303 SRs. After excluding SRs about non-acute care, not delivered in hospital or without clear evidence (either in favour or against), we select 48 SRs that generated 21 strong recommendations based on high quality evidence. The group of experts considered valid and reliable a total of 18 quality indicators: eight referred to prepartum care, eight referred to delivery, one referred to postpartum and one referred to incomplete miscarriage. These quality indicators are currently being tested for their validity, reliability and feasibility in a pilot study.
Conclusions: It is possible and feasible to develop evidence-based quality indicators to measure the appropriateness of care in Obstetrics. High-quality SRs that explicitly express support for or against an intervention are reliable and accessible tools for generating indicators of quality of care, once considered to be the nuances of clinical practice, and help to make the indicators coherent.