Building Knowledge in Maternal and Infant Care
Kiran Massey (University of British Columbia and BC Women’s Hospital and Health Centre, Canada), Tara Morris (University of British Columbia and BC Women’s Hospital and Health Centre, Canada) and Robert M. Liston (University of British Columbia, Canada)
Copyright: © 2009
Our ultimate goal as obstetric and neonatal care providers is to optimize care for mothers and their babies. As such, we need to identify practices that are associated with good outcomes. Although the randomized controlled trial is the gold standard for establishing the benefits of interventions, trials are very expensive and must be reserved for the most important of clinical questions. As an alternative, continuous quality improvement involves iterative cycles of practice change and audit of ongoing clinical care. An obvious prerequisite to this is ongoing data collection about interventions and outcomes, as well as demographics, pregnancy characteristics, and neonatal care that may affect the intervention- outcome relationship. In Canada (as in some other developed countries), much of the country is covered by regional reproductive care databases. These collect information on maternal demographics, pregnancy characteristics, labour and delivery, and basic information on maternal and perinatal outcomes. The primary objective of these databases is to monitor geographical trends and disparities in health outcomes. As such, there is little information about interventions, especially outside the period of labour and delivery. Also, there is no standardization of definitions, and efforts to produce a “minimal dataset” have not yet yielded agreement, even after many years of work. A more comprehensive system is required. Moving in this direction would serve many purposes: efficiency, economy in the setting of shrinking budgets, standardization of definitions, collaboration, and creation of stable background data collection onto which researchers could “clip” extra data required for specific studies. These activities would lay the foundation for the electronic health record, which cannot build its foundation on the “Tower of Babel” that is our current definitional structure in women’s health and obstetrics, in particular. Continuous quality improvement efforts and interaction with regional reproductive care programmes will facilitate translation and transfer of knowledge to care-givers and patients. These efforts raise concerns about privacy and security which remain major barriers to the EHR. However, security must be balanced with the need for health information.
The Canadian Perinatal Network (Cpn)
The CPN is made up of Canadian researchers from 22 tertiary perinatal units across Canada who collaborate on research issues relating to perinatal health. The CPN was born of a desire to generate new knowledge in the area of obstetric care, by using a continuous quality improvement approach to study clinical practice. This approach is based on the desire to identify those practices that are associated with good outcomes for mothers and babies, correcting for potential confounders of that relationship. The approach is predicated on the PDSA cycle and is designed to improve the quality of care (7). (Figure 1)
Figure 1. Top
PDSA Cycle (‘Plan’, ‘Do’, ‘Study’, ‘Act’)
Continuous Quality Improvement: The “Psda” Approach
The actual approach involves the following steps: ‘Plan’, ‘Do’, ‘Study’, and then ‘Act’.