Building Knowledge in Maternal and Infant Care

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, BC W)
Copyright: © 2009 |Pages: 24
DOI: 10.4018/978-1-60566-078-3.ch008
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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.
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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.

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’.

Complete Chapter List

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Editorial Advisory Board
Table of Contents
Neil Pattison
Emma Parry, David Parry
Emma Parry, David Parry
Chapter 1
Peter Stone
Improving women’s health is a vital task for the world. The consequences of obstetric and gynecological disease are serious both for the women... Sample PDF
An Introduction to Women's Health and Informatics
Chapter 2
Premila Fade
Principlism (derived from common sense morality) is the most common theory used within the healthcare sphere. The elements of this theory are... Sample PDF
Women's Health Informatics: The Ethical and Legal Issues
Chapter 3
David Parry
Recording information about symptoms, observations, actions, and outcomes is a key task of health informatics. Standardization of records is vital... Sample PDF
Coding and Messaging Systems for Women's Health Informatics
Chapter 4
Gareth Parry
Women’s health in primary care is a large part of the generalist’s practice. Information technology (IT) is now an integral part of the generalist’s... Sample PDF
Women's Health Informatics in the Primary Care Setting
Chapter 5
Emma Parry
The seamless electronic health record is often hailed as the holy grail of health informatics. What is an electronic health record? This question is... Sample PDF
The Electronic Health Record to Support Women's Health
Chapter 6
Graham Parry
Information technology and communication systems have made imaging in women’s health easier at many levels. There are now many commercial systems on... Sample PDF
Imaging and Communication Systems in Obstetrics and Gynecology
Chapter 7
Emma Parry
Pregnancy is unique in medicine in providing a discrete event with a fixed end. It is well suited to data collection and statistical assessment.... Sample PDF
Statistical Measures in Maternity Care
Chapter 8
Kiran Massey, Tara Morris, Robert M. Liston
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... Sample PDF
Building Knowledge in Maternal and Infant Care
Chapter 9
Malcolm Battin, David Knight, Carl Kuschel
Neonatal care is an extremely data-intensive activity. Physiological monitoring equipment is used extensively along with web-based information tools... Sample PDF
Informatics Applications in Neonatology
Chapter 10
Jenny Westgate
During pregnancy the fetus requires an adequate supply of oxygen and clearance of carbon dioxide which is a waste product of metabolism. In fetal... Sample PDF
Computerizing the Cardiotocogram (CTG)
Chapter 11
Liron Pantanowitz
Automation and emerging information technologies are being adopted by cytology laboratories around the world to augment Pap test screening and... Sample PDF
Computer Assisted Cervical Cytology
Chapter 12
Laurie Elit, Susan Bondy, Michael Fung-Kee-Fung, Prafull Ghatage, Tien Le, Barry Rosen, Bohdan Sadovy
Ovarian cancer affects 2,400 women annually in Canada with a case fatality ratio of 0.70. There are several practice guidelines that indicate women... Sample PDF
Informatics and Ovarian Cancer Care
Chapter 13
Jamila Abuidhail
Information and communication technologies include computers, telecommunication, digital networks, and television. Using informatics in healthcare... Sample PDF
Women's Health and Health Informatics: Perinatal Care Health Education
Chapter 14
Shona Kirtley
In an age where health professionals lead very busy working lives, electronic information sources provide ease of access to vast amounts of health... Sample PDF
Electronic Information Sources for Women's Health Knowledge for Professionals
Chapter 15
David Parry
Decision analysis techniques attempt to utilize mathematical data about outcomes and preferences to help people make optimal decisions. The... Sample PDF
Computerised Decision Support for Women's Health Informatics
Chapter 16
Michelle Brear
The influence of organizational factors on the success of informatics interventions in healthcare has been clearly demonstrated. This health... Sample PDF
Organizational Factors: Their Role in Health Informatics Implementation
Chapter 17
Josipa Kern
When things go well then often it is because they conform to standards (ISO, 2005). According to the Oxford Dictionary of Modern English, there is a... Sample PDF
Standardization in Health and Medical Informatics
Chapter 18
Elske Ammenwerth, Stefan Gräber, Thomas Bürkle, Carola Iller
This chapter summarizes the problems and challenges which occur when health information systems are evaluated. The main problem areas presented are... Sample PDF
Evaluation of Health Information Systems: Challenges and Approaches
Chapter 19
Pirkko Nykänen
eHealth refers to use of information and communication technologies to improve or enable health and healthcare. eHealth broadens the scope of health... Sample PDF
eHealth Systems, Their Use and Visions for the Future
Chapter 20
Nilmini Wickramasinghe, Santosh Misra, Arnold Jenkins, Douglas R. Vogel
Superior access, quality and value of healthcare services has become a national priority for healthcare to combat the exponentially increasing costs... Sample PDF
The Competitive Forces Facing E-Health
About the Contributors