Caesarean Section Clinical Trial
Official title:
Current Dutch Practice on Caesarean Sections: Identification of Barriers and Facilitators for Optimal Care.
Caesarean (CS) delivery rates in the Netherlands increased from 5 to 15% the last 20 years.
CSs have no clear benefit for overall neonatal outcome and are associated with higher
maternal complications and high costs. Dutch guidelines offer clear recommendations on
factors that have a direct effect on the decision to perform a CS.
Hypothesis: there is incomplete adherence to the recommendations from the guidelines on CS
among Dutch gynaecologists.
This study consists of four phases:
1. Development of quality indicators: A set of quality indicators regarding the process,
structure and outcome of care will be developed according to the RAND-modified Delphi
method. A representative, national expert panel consisting of 12 to 15 obstetricians
and midwives will participate.
2. Current care study: The current Dutch care will be studied in 20 hospitals (N=80
gynaecologists). 1000 files on performed CSs are analyzed regarding the adherence to
the developed quality indicators. To get insight into Dutch practices compared to
international data, basic obstetrical data will be extracted from the delivery
database.
3. Barrier analysis: A barrier analysis will be carried out based on the results of the
current care study. Two groups of hospitals will be identified in the upper and lower
extremes of the 'adherence distribution': 5 hospitals with the lowest and 5 hospitals
with the highest adherence scores. Factors that determine the decision to perform a CS
or not (barriers and facilitators) will be analyzed in both groups using
semi-structured interviews among 15-20 professionals and 15-20 patients. A
questionnaire will be used to study the 'prevalence' of these factors among all
obstetric gynaecologists in the Netherlands and among 200 patients.
4. Controlled before- and-after (CBA) study: Based on the outcomes of the current care
study and the barrier analysis, a tailor made implementation strategy will be developed
in order to increase adherence to the CS quality indicators. Target groups will be
selected with focus on women with both a high incidence of the indicator and low
indicator adherence. The strategy will be executed and evaluated in a CBA-study in 12
hospitals (6 intervention, 6 control) in terms of effectiveness, experiences and costs.
The sample size will be dependent on the target group and adherence to the quality
indicators regarding this target group. These data will be available after performing
the current care and the barrier study.
n/a
Observational Model: Case Control, Time Perspective: Retrospective
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