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INTRODUCTION
For the last decades, the Netherlands is facing relatively high perinatal and maternal mortality and morbidity rates. Two major issues that need special attention in order to contribute to better quality of perinatal and maternal care, are active patient-involvement and alteration in the coordination of perinatal and maternal care.
Previous use of web-based applications that involve care clients and providers show positive effects on both aforementioned issues. Therefore, this project introduces an online, individual, secured personal health community (PHC) for the pregnant woman entering maternity care, referred to as MyPregn@ncy.
AIM
The overall aim of the project is to evaluate the effects of the use of MyPregn@ncy in Dutch maternity care. To achieve this, four explicit tasks have been formulated:
1.To determine the effects of the use of MyPregn@ncy on the safety and quality of perinatal and maternal health care. Main aspects concerning this question are quality of care from the perspective of the client and (indicators for) perinatal and maternal mortality and morbidity.
2.To determine the effect of the use of MyPregn@ncy on the collaboration within professionals of multidisciplinary perinatal and maternal health care.
3.To evaluate the process of the use of MyPregn@ncy.
4.To determine if MyPregn@ncy is a suitable tool for changes in maternal health care consumption and costs.
METHODS
INTERVENTION MyPregn@ncy has various functionalities through which the pregnant woman can share her personal, (medical) information with other members of her PHC. Beside care providers, she can invite her partner, a family member or a close friend. In order to support the pregnant woman in realizing and processing her own maternal care period, several medical applications will be available for her, such as risk profiling questionnaires for the development of preeclampsia, postpartum heamorrhage or depression. Easy accessible communication tools encourage sharing of information and involving of all professional disciplines when feedback or interference is desired or needed.
PRIMARY OUTCOME MEASURES Primary outcome measures concern safety and efficacy of perinatal and maternal health.
1a. Quality of care from the perspective of the mother.
1b. (Indicators for) perinatal and maternal mortality and morbidity: antepartum, intrapartum or neonatal death, preterm birth, gestational age at delivery, birth weight, APGAR scores after 5 minutes, admissions to neonatal intensive care units, incidence and seriousness preeclampsia, incidence and seriousness postpartum haemmorhage.
1c. Maternal psychosocial outcomes: psychosocial and social support, incidence and seriousness depression.
1d. Breastfeeding initiation and duration.
SECONDARY OUTCOME MEASURES
2. Collaboration between maternal health care professionals.
3. Process evaluation outcomes:
3a. Use of MyPregn@ncy: number of initiated communities, number of users, number of times users log in, number of members involved in a personal community, information on functionalities and medical applications that are used.
3b. User experiences with MyPregn@ncy: satisfaction of use, identification of factors that determine success or failure of MyPregn@ncy, adequacy of care.
4. Consumption and costs of maternal health.
DATA COLLECTION, MANAGEMENT AND ANALYSIS
A baseline-measurement is performed before the release of MyPregn@ncy, while follow-up measurements on perinatal and maternal health outcomes, collaboration within care professionals, and care consumption and costs are performed after two years of availability of MyPregn@ncy. Additionally, the use and experiences regarding MyPregn@ncy will be evaluated.
Data for each measurement are collected from over 500 clients of primary midwife practices and secondary/tertiary maternal care hospitals in Nijmegen. Clients are informed and offered MyPregn@ncy at their first visit at a midwife or gynaecologist, usually around 10-12 weeks of pregnancy. Data are gathered using questionnaires and national databases.
Effects of MyPregn@ncy on perinatal and maternal health outcomes are tested using logistic regression techniques for multivariate analyses. Special attention is given to the influence of socio-economical status and autochthonous/allochthonous origin on outcome measures. Qualitative data-analysis consists of a framework analysis for the evaluation of quality improvement interventions.
EXPECTATIONS
MyPregn@ncy is an innovative intervention, with which we strive to a revolution in the organisation of perinatal and maternal care. Key-issues are active participation, engagement and risk-management of the pregnant woman in the care for herself and her baby, and better collaboration within all involved care professionals during pregnancy, birth and postnatal period. We strongly expect that, by changing these issues, the quality and medical outcomes of Dutch maternal care will improve.