Quality Improvement with Outcome Data in Integrated Obstetric Care Networks: Evaluating Collaboration and Learning Across Organizational Boundaries with an Action Research Approach.

Anne Louise Depla, Anna W Kersten, Marije Lamain-de Ruiter, Marielle Jambroes, Arie Franx, Inge M Evers, Bettine Pluut, Mireille N Bekker
Author Information
  1. Anne Louise Depla: Department of Obstetrics and Gynaecology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands. ORCID
  2. Anna W Kersten: Department of Public Health, Julius Centre, University Medical Centre Utrecht, Utrecht, the Netherlands.
  3. Marije Lamain-de Ruiter: Department of Obstetrics and Gynaecology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands. ORCID
  4. Marielle Jambroes: Department of Public Health, Julius Centre, University Medical Centre Utrecht, Utrecht, the Netherlands. ORCID
  5. Arie Franx: Department of Obstetrics and Gynaecology, Erasmus MC Sophia, Rotterdam, the Netherlands. ORCID
  6. Inge M Evers: Department of Obstetrics and Gynaecology, Meander Medical Centre, Amersfoort, The Netherlands. ORCID
  7. Bettine Pluut: Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands. ORCID
  8. Mireille N Bekker: Department of Obstetrics and Gynaecology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands. ORCID

Abstract

Introduction: Patient-reported outcome and experience measures (PROM and PREM) are used to guide individual care and quality improvement (QI). QI with patient-reported data is preferably organized around patients, which is challenging across organisations. We aimed to investigate network-broad learning for QI with outcome data.
Methods: In three obstetric care networks using individual-level PROM/PREM, a learning strategy for cyclic QI based on aggregated outcome data was developed, implemented and evaluated. The strategy included clinical, patient-reported, and professional-reported data; together translated into cases for interprofessional discussion. This study's data generation (including focus groups, surveys, observations) and analysis were guided by a theoretical model for network collaboration.
Results: The learning sessions identified opportunities and actions to improve quality and continuity of perinatal care. Professionals valued the data (especially patient-reported) combined with in-dept interprofessional discussion. Main challenges were professionals' time constraints, data infrastructure, and embedding improvement actions. Network-readiness for QI depended on trustful collaboration through connectivity and consensual leadership. Joint QI required information exchange and support including time and resources.
Conclusions: Current fragmented healthcare organization poses barriers for network-broad QI with outcome data, but also offers opportunities for learning strategies. Furthermore, joint learning could improve collaboration to catalyse the journey towards integrated, value-based care.

Keywords

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Word Cloud

Created with Highcharts 10.0.0dataQIcarelearningoutcomepatient-reportedcollaborationinterprofessionalmeasuresqualityimprovementnetwork-broadstrategydiscussionincludingopportunitiesactionsimproveperinataltimehealthcareintegratedvalue-basedIntroduction:Patient-reportedexperiencePROMPREMusedguideindividualpreferablyorganizedaroundpatientschallengingacrossorganisationsaimedinvestigateMethods:threeobstetricnetworksusingindividual-levelPROM/PREMcyclicbasedaggregateddevelopedimplementedevaluatedincludedclinicalprofessional-reportedtogethertranslatedcasesstudy'sgenerationfocusgroupssurveysobservationsanalysisguidedtheoreticalmodelnetworkResults:sessionsidentifiedcontinuityProfessionalsvaluedespeciallycombinedin-deptMainchallengesprofessionals'constraintsinfrastructureembeddingNetwork-readinessdependedtrustfulconnectivityconsensualleadershipJointrequiredinformationexchangesupportresourcesConclusions:CurrentfragmentedorganizationposesbarriersalsooffersstrategiesFurthermorejointcatalysejourneytowardsQualityImprovementOutcomeDataIntegratedObstetricCareNetworks:EvaluatingCollaborationLearningAcrossOrganizationalBoundariesActionResearchApproach

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