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Implementation of childbirth-specific patient-reported outcomes measures in the hospital setting
Investigator (PI): Gregory, Kimberly D
Performing Organization (PO): (Current): Cedars-Sinai Medical Center, Department of Obstetrics and Gynecology / (310) 423-9999
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2018
Final Year: 2021
Record Source/Award ID: PCORI/DI-2017C1-6489
  • HSRR / 2434
Funding: Total Award Amount: $437,080
Award Type: Contract
Award Information: Reports resulting from this project
Abstract: The Patient-Reported Outcomes Management Information System (PROMIS) was funded by the National Institutes for Health (NIH) in 2004 to develop standardized methods for measuring patient-reported outcomes (PROs). To date, PROs have largely been used for clinical research purposes and to guide clinical care. But now, PROs are becoming integrated into "performance measurement" of hospitals and physicians. Twenty-five percent of hospitals' value-based purchasing (VBP) incentive payments from Centers for Medicare and Medicaid Services (CMS) (on average, $2 million per hospital) are determined by how patients evaluate their stay on 8 dimensions that make up the Patient Experience of Care domain within the VBP framework. These include generic questions regarding doctor/nurse communication, responsiveness of hospital staff, and pain management as measured through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Scores are based on the aggregate response from medical, surgical, and maternity care service lines, and these scores provide feedback for hospitals to improve their services. However, just as a version of HCAHPS was derived specifically for surgical patients because their needs are different from medical patients, childbirth-specific results are needed to address dissatisfaction among maternity patients. While hospitals are now learning regarding the surgical service line through preoperative and postoperative surveys, they do not know how to improve their maternity scores. This fact was emphasized at the Expanded Stakeholders meeting. The Childbirth Experience Survey fills this evidence gap. We have developed the Childbirth Experience Survey to be used before birth to allow the opportunity for discussion between patients and providers, and to be used after birth to determine whether women received the services and outcomes they wanted. This instrument fills an existing gap and now needs to be implemented in a multi-hospital environment. Under our original methods award, the goal was to apply the Patient-Reported Outcomes Management Information System (PROMIS) methodology to describe what women most want from childbirth services, and in doing so, provide a foundation for the development of childbirth-specific PROs that could be useful for childbirth hospital performance measurement. Using community-based research techniques and PROMIS methodology, we performed a comprehensive and systematic literature review to identify self-reported survey items regarding predisposing conditions, childbirth PREs (patient-reported value expectations measured antepartum) and PROs (patient-reported outcomes measured postpartum) associated with women's evaluation of their childbirth experience. We identified 5,880 PRE/PRO items that were mapped to 19 domains and 58 sub-domains within an empirical conceptual framework. The PRE/PRO domains were validated and complemented by focus groups. We worked with our community partners to develop a 20-minute survey to assess women's childbirth priorities and conducted an observational study using national survey response panels organized through the Nielsen company (Nielsen). Women responding to the antepartum survey then participated in a postpartum follow-up survey administered by Nielsen to collect information regarding their childbirth experience (PROs). Of 2,757 respondents to the antepartum survey, the majority (81.6%; N=2,250) were anticipating or considering a vaginal delivery in a hospital and were reported on. Data were collected on women planning a cesarean delivery or out-of-hospital birth (e.g., birth center or home birth), but are not included in this report. Wide variation existed regarding each PRE, e.g., hospital services desired by nulliparas vs. multiparas were different: nulliparas were more likely to want to avoid medical interventions and to receive information regarding baby care and feeding. Predisposing conditions, such as maternal confidence and ability to cope well with pain, appeared frequently as predictors in the models. Of 500 women who answered the postpartum survey and who labored and delivered in a hospital, key findings included 1) specific patient characteristics, PREs, PROs, and gaps remained important predictors of hospital satisfaction; 2) the strongest predictors were items in the domains of staff communication, compassion, empathy, and respect; and 3) 23 specific PROs were identified that were strongly related to hospital satisfaction. From this information, a conceptual framework and item pool were finalized. The item pool consisted of 60 key predisposing conditions and 100 PREs/PROs. Our primary objective is to conduct a pilot project to disseminate and implement the Childbirth Experience Survey into 10 hospitals. We will establish a process to collect data and develop a hospital-specific report that describes childbirth PREs (patient-reported value expectations collected in the antepartum period > 36 weeks of gestation) and PROs (patient-reported outcomes collected 8-12 weeks postpartum). The data collected will be analyzed to create hospital-specific reports for improving patient childbirth experiences and ratings of hospital satisfaction. We have two specific study aims: (1) the first aim is to disseminate and implement a Childbirth Experiences Survey in a diverse group of hospitals; and (2) the second aim is to evaluate the dissemination and implementation (D&I) process in different types of hospitals and patient populations and identify opportunities for hospitals to improve women's experience of childbirth and ratings of hospitals. Information learned can be used to achieve sustainability in the pilot hospitals and provide the foundation for dissemination and implementation in other facilities.
MeSH Terms:
  • Communication
  • Female
  • Focus Groups
  • Hospitalization
  • Hospitals
  • Humans
  • National Institutes of Health (U.S.)
  • Observational Studies as Topic
  • Obstetrics /standards
  • * Outcome Assessment, Health Care
  • Parity
  • * Parturition
  • * Patient Reported Outcome Measures
  • Patient Satisfaction
  • Postpartum Period
  • Pregnancy
  • Surveys and Questionnaires
  • United States
Country: United States
State: California
Zip Code: 90048
UI: 20184278
Project Status: Ongoing
Record History: ('2019: Project extended to 2021',)