Good practices in perinatal mental health during the COVID-19 pandemic: a report from task-force RISEUP-PPD COVID-19

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Perinatal Risk Factors and Outcome Coding in Clinical and Administrative Databases.

BACKGROUND AND OBJECTIVES: Administrative databases may allow true population-based studies and quality improvement endeavors, but the accuracy of billing codes for capturing key risk factors and outcomes needs to be assessed. We sought to describe the performance of a statewide administrative database and the clinical database from the California Perinatal Quality Care Collaborative (CPQCC). METHODS: This population-based retrospective cohort study linked key perinatal risk factors and outcomes from the 133-unit CPQCC database to relevant billing codes from administrative maternal and newborn inpatient discharge records, for 50 631 infants born from 2006 to 2012. Using the CPQCC record as the gold standard, we calculated the positive predictive value, negative predictive value, and Matthews correlation coefficient for each item, then evaluated comparative performance across units. RESULTS: The Matthews correlation coefficient was highest (>0.7; strong positive correlation) for multiple delivery, Cesarean delivery, very low birth weight, maternal hypertension, maternal diabetes, patent ductus arteriosus, in-hospital death, patent ductus arteriosus and retinopathy of prematurity surgeries, extracorporeal life support, and intraventricular hemorrhage. Maternal chorioamnionitis, fetal distress, retinopathy of prematurity staging, chronic lung disease, and pneumothorax were the least reliably coded. Maternal factors and delivery details were more reliably coded in the maternal inpatient record than the newborn inpatient record. CONCLUSIONS: Several important perinatal risk factors and outcomes are highly congruent between these administrative and clinical databases. Several subjective risk factors and outcomes are appropriate targets for data improvement initiatives. The ability for timely extraction of administrative inpatient data will be key to their usefulness in quality metrics.

A validation study of the Australian Maternity Care Classification System.

BACKGROUND: The Maternity Care Classification System is a novel system developed in Australia to classify models of maternity care based on their characteristics. It will enable large-scale evaluations of maternal and perinatal outcomes under different models of care independently of the model's name. AIM: To assess the accuracy, repeatability and reproducibility of the Maternity Care Classification System. METHOD: All 70 public maternity services in New South Wales, Australia, were invited to classify three randomly allocated model case-studies using a web-based survey tool and repeat their classifications 4-6 weeks later. Accuracy of classifications was assessed against the correct values for the case-studies; repeatability (intra-rater reliability) was analysed by percent agreement and McNemar's test between the same participants in both surveys; and reproducibility (inter-rater reliability) was assessed by percent agreement amongst raters of the same case-study combined with Krippendorff's alpha coefficient for a subset of characteristics. RESULTS: The accuracy of the Maternity Care Classification System was high with 90.8% of responses correctly classified; was repeatable, with no statistically significant change in the responses between the two survey instances (mean agreement 91.5%, p>0.05 for all but one variable); and was reproducible with a mean percent agreement across 9 characteristics of 83.6% and moderate to substantial agreement as assessed by a Krippendorff's alpha coefficient of 0.4-0.8. CONCLUSION: The results indicate the Maternity Care Classification System is a valid system for classifying models of care in Australia, and will enable the legitimate evaluation of outcomes by different models of care.

The development of a classification system for maternity models of care.

BACKGROUND: A lack of standard terminology or means to identify and define models of maternity care in Australia has prevented accurate evaluations of outcomes for mothers and babies in different models of maternity care. OBJECTIVE: As part of the Commonwealth-funded National Maternity Data Development Project, a classification system was developed utilising a data set specification that defines characteristics of models of maternity care. METHOD: The Maternity Care Classification System or MaCCS was developed using a participatory action research design that built upon the published and grey literature. RESULTS: The study identified the characteristics that differentiate models of care and classifies models into eleven different Major Model Categories. CONCLUSION: The MaCCS will enable individual health services, local health districts (networks), jurisdictional and national health authorities to make better informed decisions for planning, policy development and delivery of maternity services in Australia.

[Health care levels and minimum recommendations for neonatal care]. / Niveles asistenciales y recomendaciones de mínimos para la atención neonatal.

A policy statement on the levels of care and minimum recommendations for neonatal healthcare was first proposed by the Standards Committee and the Board of the Spanish Society of Neonatology in 2004. This allowed us to define the level of care of each center in our country, as well as the health and technical requirements by levels of care to be defined. This review takes into account changes in neonatal care in the last few years and to optimize the location of resources. Facilities that provide care for newborn infants should be organized within a regionalized system of perinatal care. The functional capabilities of each level of care should be defined clearly and uniformly, including requirements for equipment, facilities, personnel, ancillary services, training, and the organization of services (including transport) needed to cover each level of care.

We can do better: improving perinatal health in America.

The United States spends more on perinatal healthcare than any other nation, yet it consistently ranks near the bottom on most standard measures of perinatal health. This article examines how we can do better, based on the life course perspective and the ecological model. Collectively, these paradigms suggest the need for an expanded approach to improving perinatal health in America, one that emphasizes not only risk reduction during pregnancy but also health promotion and optimization across the life course. The approach needs to be both clinical and population based, addressing individual factors as well as social determinants. This article concludes with recommendations for increasing healthcare access, improving healthcare quality, investing in wellness, strengthening families and communities, and supporting research in perinatal health.

Exploratory analysis of medical coding practices: the relevance of reported data quality in obstetrics-gynaecology.

We aimed at identifying a suitable data analysis approach to investigate potential patterns in the current medical coding in obstetrics and perinatal care. We processed the data reported for 2006 in DRG files from three Romanian university clinics of obstetrics-gynaecology and found substantial differences in the coding practices. Based on the evidence we found with a poor usage of the coding instruments, we concluded that using objective methods and quantifiable measures in analyzing the medical coding could help putting things into the right perspective and bring support for the need for formal education of medical record administrators and coders where such programmes do not exist, e.g. in Romania.

Rèseau sécurité naissance dans les pays de la Loire

Il presente les actualités du reseau, la mission Mattei sur la périnatalité, journées scientifiques du réseau, textes sur la périnatalité, éditoriaux, les différents niveaux de soins périnatals, les commissions, organisation.

Análisis de la mortalidad perinatal en el Bages (Barcelona) / Analysis of perinatal mortality in Bages (Barcelona)

Objetivo: Conocer la mortalidad perinatal del hospital de referencia de la atención materno-infantil en la comarca del Bages y analizar las causas de las muertes. Método: Análisis retrospectivo de las historias clínicas del hospital y de los servicios de atención a la mujer de atención primaria de los casos de muerte perinatal en los años 1997 y 1998. Se obtuvo la información mediante un cuestionario estructurado con las variables de interés. Se evaluaron las actuaciones obstétricas según los criterios de la Encuesta Confidencial de las Muertes Perinatales inglesa. En los casos de actuación subóptima, se clasificaron los factores evitables aparecidos. Resultados: Hubo 20 muertes perinatales en 19 mujeres gestantes. Se pudieron catalogar 17 actuaciones obstétricas: de ellas 7 fueron subóptimas (cinco de grado 1 y dos de grado 2) sin que existiera claramente un factor evitable relacionado con la muerte. La mortalidad perinatal hospitalaria fue de 12,3. Un 6,6 per cent del total de partos del hospital fueron en mujeres inmigrantes mientras que el 21 per cent de las muertes perinatales aparecieron en dichas mujeres. el 42 per cent de las gestantes estudiadas llevaban una doble atención: pública y privada. Se detectó algún déficit en el traspaso de información entre ambos tipos de servicios. Se realizó autopsia en el 84 per cent de las muertes .Conclusiones: El estudio del tipo de actuación obstétrica y de los factores relacionados con la mortalidad perinatal se ha mostrado muy útil para poder analizar los problemas de atención sanitaria y planificar cambios tanto a nivel de atención primaria como de la atención hospitalaria. Es aconsejable en Cataluña priorizar el estudio de la mortalidad perinatal en colectivos de especial riesgo como las mujeres inmigrantes. El contacto de servicios es un instrumento útil para priorizar objetivos del Plan de Salud en la cartera de servicios de los hospitales (AU)

Implantación del sistema de información perinatal / Use of a perinstal information system

Se presenta una experiencia rual en el proceso de implantación del Sistema Informativo Perinatal en un Hospital de II nivel. Este sistema de información permite al usuario contar con un mejor conocimiento de la población accesible, sus indicadores de salud, la identificación de factores de riesgo y causas de morbimortalidad mas frecuentes. Se consideraron 3 componentes: La utilización normativa de la Historia Clínica perinatal Base, con la asignación de tareas específicas y responsables en su llenado, la normatización en el llenado de la misma y el procesamiento/analisis de la información. El trabajo se consolidó en 10 meses alcanzándose una atención integral a la embarazada, parturienta, puérpera y recien nacido. A traves de la metodología utilizada, se demuestra que una atención integral a la embarazada y el uso adecuado de instrumentos como la Historia Clínica Perinatal Base, permiten brindar calidad en las acciones, mejorar indicadores y disminuir el riesgo materno perinatal.