Connecting Obstetric, Maternity, Pediatric and Preventive chiLd hEalTh carE: the COMPLETE project

Integrated birth care is designed to improve the outcome of pregnancy and the child’s future health, for which the first 1000 days of life are pivotal. In the Netherlands different care professionals and health care organizations are involved in birth care. These include primary and secondary/tertiary obstetric care, maternity care, pediatric/neonatal care, family medicine and preventive child health care (PCHC) organizations. These are joined in Obstetric Collaborations Networks (OCNs), except for PCHC in most cases. In 2016 the Inspectorate Health Care and Youth (ICHY) concluded that collaboration between OCNs and PCHC was unsatisfactory. It is not known which mechanisms underlie this collaboration, and if strengthening the facilitators and resolving the barriers will result in better collaboration and improved health outcomes. We will address these gaps by this research proposal. The overarching goal is to improve collaboration between PCHC and the other birth care organizations and professionals. During ACTIVITY 1 we will identify the determinants of the collaboration, which determinants are to be improved and if current organization models are suitable to facilitate these changes. During ACTIVITY 2, we will develop a new multidisciplinary strategy to improve collaboration and perform a pilot test to customize the strategy within two OCNs and related PCHC organizations. During ACTIVITY 3 we will prepare a nationwide implementation plan for the new strategy, conditional it is proven successful in the pilot. The analyses during ACTIVITY 1 and during ACTIVITY 2 will be based on the diagnostic model proposed by D’ Amour for organizations grounded in collaboration. The model distinguishes 4 dimensions: governance, shared goals & vision, formalization and internalization, which entail 10 determinants. We will use a mixed methods approach and encourage major influence by all stakeholders, including clients and birth care professionals. Research methods during ACTIVITY 1 include: * Qualitative methods: - Focus group interviews will be held with four groups of stakeholders: (1) OCN professionals, (2) PCHC professionals, (3) clients and (4) policy makers, health insurers, lawyers and organization experts. - The critical incident approach (CIA) will be used within 4 consortia and related PCHC organizations to evaluate 64 cases of successful or unsuccessful collaboration. CIA is an event based research strategy using semi-structured interviews to elicit detailed descriptions of situations in which the trajectory before, during and after birth was subject to disruptions with potentially problematic or successful outcomes. * Quantitative research: Questionnaires will be taken from all birth care professionals in the Netherlands, which will be developed on basis of the results of the focus group interviews and CIA. * Integration of obtained qualitative and quantitative data into an overview of the determinants to be included in the new strategy, and advice of the organization model(s) suitable to capture these determinants. Research methods during ACTIVITY 2 include * Preparation of the pilot: - engaging the pilot organizations (starting one year before the start of the pilot), - development of the new strategy for collaboration, based on the results in ACTIVITY 1 - collaboration with the program BabyConnect to warrant digital data transfer between participating OCNs and PCHC organizations. * Execution of the pilot by which we will further develop the new strategy in an iterative process using principles of Participatory Action Research. We will assess the collaboration at baseline and subsequently twice during the pilot, in order to evaluate the effects of the new strategy on health outcomes and experienced quality of care and collaboration, and to adapt the strategy in this iterative process if needed. Outcomes will include Value Based Health Outcomes (as developed by ICHOM), child’s health outcomes during the first half year of life as captured by PCHC, and the experiences of healthcare professionals. Focus group interviews with all stakeholders during the pilot will be held in order to assess if the new strategy needs adaptations on the basis of a cyclic evaluation. ACTIVITY 3. Once proven successful we will develop a nationwide implementation plan for the new strategy. We will advise on further improvements of the strategy based on the final evaluation of the pilot. Four regional birth care consortia, the NCJ, GGD GHOR and ActiZ support our proposal. Clients highly value the aims of our project (see their assessment of the project idea), and will be strongly involved across the study period. Primary and secondary/tertiary birth care will be also actively involved too. Finally, we will collaborate closely with BabyConnect, enabling digital data transfer between the participating OCNs and the PCHC organizations. Duration: 48 months. Budget requested from ZonMw: 449,997 euros.