Developing a set of consensus indicators to support maternity service quality improvement: using Core Outcome Set methodology including a Delphi process.
Bunch KJ., Allin B., Jolly M., Hardie T., Knight M.
OBJECTIVE: To develop a core metric set to monitor the quality of maternity care. DESIGN: Delphi process followed by a face-to-face consensus meeting. SETTING: English Maternity units. POPULATION: Three representative expert panels: service designers, providers and users. MAIN OUTCOME MEASURES: Maternity care metrics judged important by participants. METHODS: Participants were asked to complete a two phase Delphi process, scoring metrics from existing local maternity dashboards. A consensus meeting discussed the results and re-scored the metrics. RESULTS: 125 distinct metrics across six domains were identified from existing dashboards. Following the consensus meeting, 14 metrics met the inclusion criteria for the final core set: Smoking rate at booking Rate of birth without intervention Caesarean section delivery rate in Robson group 1 women Caesarean section delivery rate in Robson group 2 women Caesarean section delivery rate in Robson group 5 women 3rd and 4th degree tear rate among women delivering vaginally Rate of postpartum haemorrhage of 1500ml or greater Rate of successful vaginal birth after a single previous caesarean section Smoking rate at delivery Proportion of babies born at term with an Apgar score <7 at 5 minutes Proportion of babies born at term admitted to the neonatal intensive care unit Proportion of babies readmitted to hospital at <30 days of age Breastfeeding initiation rate Breastfeeding rate at 6-8 weeks CONCLUSIONS: Core outcome set methodology can be used to incorporate the views of key stakeholders in developing a core metric set to monitor the quality of care in maternity units thus enabling improvement. This article is protected by copyright. All rights reserved.