Background
Methods
Study design
Participants
Rating determinants by experts: First Delphi round
Rating determinants by experts: Second Delphi round
Results
Identification of existing quality indicators in birth care
Translating indicators into determinants
Determinant selection by Delphi consultation
Determinant | Type of indicator | Rating on: | Median score Likert scale | Consensus (%) | Conclusion round 1 | Conclusion round 2 |
---|---|---|---|---|---|---|
(1–7) | (80% consensus) | (80% consensus) | ||||
Domain: effectiveness | ||||||
Written agreements on care aspects (i.e. by hospital care, obstetricians) | Structure | Relevance | 7 | 100 | Include | |
Feasible | 6 | 87,5 | ||||
Structural evaluation of the care provided in the birth centre | Structure | Relevance | 7 | 93,7 | Include | |
Feasible | 6 | 83,4 | ||||
Maternity care assistant present during laboura
| Process | Relevance | 6 | 87,5 | Include | |
Feasible | 6,5 | 79,2 | ||||
(Integrated) ICT system with hospital and midwifery practices | Structure | Relevance round 1 | 6 | 75 | Submit again | |
Feasible round 1 | 5 | 54,3 | ||||
Relevance round 2 | 6 | 90,5 | Include | |||
Feasible round 2 | 6 | 76,2 | ||||
Domain: safety | ||||||
Facilities at a birth centre in relation to emergency care (i.e. CPR resuscitation) | Structure | Relevance | 7 | 95,9 | Include | |
Feasible | 7 | 97,9 | ||||
Joint (interdisciplinary) emergency care training | Process | Relevance | 6 | 95,8 | Include | |
Feasible | 6 | 87,5 | ||||
Agreements with ambulance service and nearest hospital about urgent referrals | Structure | Relevance | 7 | 89,6 | Include | |
Feasible | 6 | 77 | ||||
Domain: timeliness | ||||||
Necessary transport time from birth centre to hospital | Process | Relevance | 7 | 100 | Include | |
Feasible | 7 | 96 | ||||
In case of referral from the birth centre durante partu: required time between decision to refer and treatment in hospital | Process | Relevance | 7 | 95,9 | Include | |
Feasible | 6 | 81,3 | ||||
Domain: efficiency | ||||||
In case of referral from the birth centre durante partu: guaranteed access to the hospital with which agreements were made | Process | Relevance | 7 | 100 | Include | |
Feasible | 6 | 87,6 | ||||
Distance between birth centre and hospital | Structure | Relevance | 7 | 98 | Include | |
Feasible | 7 | 96 | ||||
Cooperation with (almost) all relevant organizations in the region (such as midwifery practices and maternity care assistance organisations) | Process | Relevance | 6 | 89,5 | Include | |
Feasible | 6 | 81,3 | ||||
Protocols on care aspects | Structure | Relevance | 7 | 87,5 | Include | |
Feasible | 6,5 | 81,3 | ||||
Participation of birth centre in local maternity care consultation and cooperation group (VSV) | Process | Relevance | 7 | 85,4 | Include | |
Feasible | 6 | 81,3 | ||||
Indoor connection between birth centre and hospital | Structure | Relevance | 6 | 84 | Include | |
Feasible | 7 | 96 | ||||
Joint use of an electronic patient record | Structure | Relevance round 1 | 6 | 87,6 | Submit again | |
Feasible round 1 | 6 | 66,7 | ||||
Relevance round 2 | 6 | 95,2 | Include | |||
Feasible round 2 | 6 | 85,7 | ||||
System of quality improvement (i.e. accreditation) | Structure | Relevance round 1 | 6 | 70,9 | Submit again | |
Feasible round 1 | 5 | 56,3 | ||||
Relevance round 2 | 6 | 85,7 | Decision Research group: include | |||
Feasible round 2 | 5 | 80,9 | ||||
Multidisciplinary education as result of formulated points of improvement from perinatal audit | Process | Relevance round 2 | 6 | 90,5 | New in round 2 | Include |
Feasible round 2 | 6 | 83,3 | ||||
Domain: equity | ||||||
Care pathways formulated with chain partners | Structure | Relevance | 6 | 95,9 | Include | |
Feasible | 6 | 79,2 | ||||
Birth centre has vision of birth care | Structure | Relevance | 7 | 91,8 | Include | |
Feasible | 6 | 75 | ||||
Formal partnership agreement with chain partners | Structure | Relevance | 6 | 83,4 | Include | |
Feasible | 7 | 81,3 | ||||
Admission agreement for professionals who use birth care facilities at the birth centre | Structure | Relevance round 1 | 6 | 69,3 | Submit again | |
Feasible round 1 | 7 | 75,5 | ||||
Relevance round 2 | 6 | 81 | Include | |||
Feasible round 2 | 7 | 85,7 | ||||
Domain: accessibility | ||||||
24 /7 telephone accessibility birth centre | Process | Relevance | 7 | 100 | Include | |
Feasible | 7 | 98 | ||||
Physical access to birthing centre for clients (i.e. parking) | Structure | Relevance | 7 | 96 | Include | |
Feasible | 6 | 78 | ||||
Physical access to birthing centre for midwives and maternity care assistants (e.g. parking) | Structure | Relevance | 6 | 92 | Include | |
Feasible | 6 | 80 | ||||
Domain: patient-centeredness | ||||||
Facilities at a birth centre in relation to pain management (i.e. nitrous oxide) | Structure | Relevance | 6 | 100 | Include | |
Feasible | 6 | 83,7 | ||||
Continuous presence of a healthcare provider during laboura
| Process | Relevance | 7 | 98 | Include | |
Feasible | 6 | 81,3 | ||||
Structural research on client experiences | Structure | Relevance | 7 | 98 | Include | |
Feasible | 6 | 85,5 | ||||
Focusing on the patients (i.e. use individual birth plan) | Process | Relevance | 6 | 89,6 | Include | |
Feasible | 6 | 83,4 | ||||
Participation and representation of clients in organisation (i.e. in the board) | Structure | Relevance round 2 | 6 | 85,7 | New in round 2 | Include |
Feasible round 2 | 6 | 78,6 |
Scores Likert Scale (N) | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Determinant | Domaina
| Rating on: | 1 | 2 | 3 | 4 | 5 | 6 | 7 | Do not know | Total (N) | Median | Consensus (%) | Conclusion round 1 (80% consensus) | Conclusion round 2 (80% consensus) |
Adopted after first round | |||||||||||||||
Necessary transport time from birth centre to hospital | 3 | Relevance | 3 | 13 | 34 | 50 | 7 | 100 | Include | ||||||
Feasible | 2 | 4 | 14 | 30 | 50 | 7 | 96 | ||||||||
24 /7 telephone accessibility birth centre | 6 | Relevance | 2 | 6 | 42 | 50 | 7 | 100 | Include | ||||||
Feasible | 1 | 3 | 10 | 36 | 50 | 7 | 98 | ||||||||
Facilities at a birth centre in relation to pain management (i.e. nitrous oxide) | 7 | Relevance | 1 | 1 | 2 | 2 | 12 | 17 | 14 | 49 | 6 | 100 | Include | ||
Feasible | 1 | 3 | 3 | 5 | 14 | 22 | 1 | 49 | 6 | 83,7 | |||||
Written agreements on care aspects (i.e. by hospital care, obstetricians) | 1 | Relevance | 4 | 17 | 27 | 48 | 7 | 100 | Include | ||||||
Feasible | 1 | 1 | 2 | 4 | 18 | 20 | 2 | 48 | 6 | 87,5 | |||||
In case of referral from the birth centre durante partu: guaranteed access to the hospital with which agreements were made | 4 | Relevance | 3 | 9 | 36 | 48 | 7 | 100 | Include | ||||||
Feasible | 1 | 4 | 9 | 12 | 21 | 1 | 48 | 6 | 87,6 | ||||||
Distance between birth centre and hospital | 4 | Relevance | 1 | 7 | 15 | 27 | 50 | 7 | 98 | Include | |||||
Feasible | 2 | 1 | 14 | 33 | 50 | 7 | 96 | ||||||||
Continuous presence of a healthcare provider during labour | 7 | Relevance | 1 | 6 | 14 | 27 | 48 | 7 | 98 | Include | |||||
Feasible | 1 | 5 | 3 | 12 | 14 | 13 | 48 | 6 | 81,3 | ||||||
Structural research on client experiences | 7 | Relevance | 1 | 2 | 18 | 27 | 48 | 7 | 98 | Include | |||||
Feasible | 1 | 2 | 4 | 3 | 15 | 23 | 48 | 6 | 85,5 | ||||||
Physical access to birthing centre for clients (i.e. parking) | 6 | Relevance | 2 | 6 | 16 | 26 | 50 | 7 | 96 | Include | |||||
Feasible | 1 | 2 | 7 | 2 | 13 | 24 | 1 | 50 | 6 | 78 | |||||
Care pathways formulated with chain partners | 5 | Relevance | 1 | 7 | 18 | 21 | 1 | 48 | 6 | 95,9 | Include | ||||
Feasible | 1 | 8 | 7 | 14 | 17 | 1 | 48 | 6 | 79,2 | ||||||
Facilities at a birth centre in relation to emergency care (i.e. CPR resuscitation) | 2 | Relevance | 2 | 4 | 11 | 32 | 49 | 7 | 95,9 | Include | |||||
Feasible | 1 | 10 | 37 | 1 | 49 | 7 | 97,9 | ||||||||
In case of referral from the birth centre durante partu: required time between decision to refer and treatment in hospital | 3 | Relevance | 1 | 3 | 12 | 31 | 1 | 48 | 7 | 95,9 | Include | ||||
Feasible | 3 | 3 | 9 | 10 | 20 | 3 | 48 | 6 | 81,3 | ||||||
Joint (interdisciplinary) emergency care training | 2 | Relevance | 2 | 7 | 17 | 22 | 48 | 6 | 95,8 | Include | |||||
Feasible | 1 | 5 | 7 | 19 | 16 | 48 | 6 | 87,5 | |||||||
Structural evaluation of the care provided in the birth centre | 1 | Relevance | 2 | 1 | 16 | 28 | 1 | 48 | 7 | 93,7 | Include | ||||
Feasible | 2 | 4 | 8 | 18 | 14 | 2 | 48 | 6 | 83,4 | ||||||
Physical access to birthing centre for midwives and maternity care assistants (e.g. parking) | 6 | Relevance | 4 | 9 | 17 | 20 | 50 | 6 | 92 | Include | |||||
Feasible | 1 | 2 | 6 | 3 | 15 | 22 | 1 | 50 | 6 | 80 | |||||
Birth centre has vision of birth care | 5 | Relevance | 1 | 3 | 3 | 15 | 26 | 48 | 7 | 91,8 | Include | ||||
Feasible | 1 | 4 | 7 | 5 | 11 | 20 | 48 | 6 | 75 | ||||||
Cooperation with (almost) all relevant organizations in the region (such as midwifery practices and maternity care assistance organisations) | 4 | Relevance | 1 | 1 | 3 | 4 | 16 | 23 | 48 | 6 | 89,5 | Include | |||
Feasible | 2 | 1 | 6 | 8 | 14 | 17 | 48 | 6 | 81,3 | ||||||
Agreements with ambulance service and nearest hospital about urgent referrals | 2 | Relevance | 2 | 3 | 4 | 9 | 30 | 48 | 7 | 89,6 | Include | ||||
Feasible | 1 | 1 | 8 | 4 | 10 | 23 | 1 | 48 | 6 | 77 | |||||
Focusing on the patients (i.e. use of individual birth plan) | 7 | Relevance | 4 | 2 | 24 | 17 | 1 | 48 | 6 | 89,6 | Include | ||||
Feasible | 2 | 4 | 14 | 13 | 13 | 2 | 48 | 6 | 83,4 | ||||||
Maternity care assistant present during labour | 1 | Relevance | 2 | 4 | 7 | 12 | 23 | 48 | 6 | 87,5 | Include | ||||
Feasible | 2 | 2 | 5 | 2 | 12 | 24 | 1 | 48 | 6,5 | 79,2 | |||||
Protocols on care aspects | 4 | Relevance | 2 | 1 | 2 | 3 | 10 | 29 | 1 | 48 | 7 | 87,5 | Include | ||
Feasible | 3 | 1 | 4 | 3 | 12 | 24 | 1 | 48 | 6,5 | 81,3 | |||||
Participation of birth centre in local maternity care consultation and cooperation group (VSV) | 4 | Relevance | 2 | 5 | 1 | 10 | 30 | 48 | 7 | 85,4 | Include | ||||
Feasible | 1 | 1 | 6 | 3 | 13 | 23 | 1 | 48 | 6 | 81,3 | |||||
Indoor connection between birth centre and hospital | 4 | Relevance | 2 | 1 | 5 | 8 | 11 | 23 | 50 | 6 | 84 | Include | |||
Feasible | 2 | 2 | 13 | 33 | 50 | 7 | 96 | ||||||||
Formal partnership agreement with chain partners | 5 | Relevance | 2 | 1 | 5 | 5 | 15 | 20 | 48 | 6 | 83,4 | Include | |||
Feasible | 1 | 1 | 7 | 3 | 10 | 26 | 48 | 7 | 81,3 | ||||||
Adopted after second round | |||||||||||||||
Joint use of an electronic patient record | 4 | Relevance round 1 | 6 | 3 | 19 | 20 | 48 | 6 | 87,6 | Submit again | |||||
Feasible round 1 | 1 | 2 | 3 | 8 | 5 | 8 | 19 | 2 | 48 | 6 | 66,7 | ||||
Relevance round 2 | 1 | 1 | 1 | 20 | 19 | 42 | 6 | 95,2 | Include | ||||||
Feasible round 2 | 1 | 2 | 3 | 5 | 16 | 15 | 42 | 6 | 85,7 | ||||||
(Integrated) ICT system with hospital and midwifery practices | 1 | Relevance round 1 | 1 | 9 | 3 | 17 | 16 | 2 | 48 | 6 | 75 | Submit again | |||
Feasible round 1 | 1 | 3 | 4 | 12 | 3 | 9 | 14 | 2 | 48 | 5 | 54,3 | ||||
Relevance round 2 | 3 | 6 | 19 | 13 | 1 | 42 | 6 | 90,5 | Include | ||||||
Feasible round 2 | 1 | 2 | 5 | 10 | 13 | 9 | 2 | 42 | 6 | 76,2 | |||||
System of quality improvement (i.e. accreditation) | 4 | Relevance round 1 | 1 | 10 | 8 | 12 | 14 | 3 | 48 | 6 | 70,9 | Submit again | |||
Feasible round 1 | 2 | 1 | 1 | 7 | 9 | 11 | 11 | 6 | 48 | 5 | 56,3 | ||||
Relevance round 2 | 1 | 4 | 8 | 16 | 12 | 1 | 42 | 6 | 85,7 | decision Research group: include | |||||
Feasible round 2 | 2 | 1 | 3 | 15 | 10 | 9 | 2 | 42 | 5 | 80,9 | |||||
Admission agreement for professionals who use birth care facilities at the birth centre | 5 | Relevance round 1 | 1 | 3 | 4 | 6 | 10 | 18 | 7 | 49 | 6 | 69,3 | Submit again | ||
Feasible round 1 | 1 | 3 | 3 | 8 | 26 | 8 | 49 | 7 | 75,5 | ||||||
Relevance round 2 | 1 | 1 | 3 | 4 | 13 | 17 | 3 | 42 | 6 | 81 | Include | ||||
Feasible round 2 | 5 | 7 | 29 | 1 | 42 | 7 | 85,7 | ||||||||
Multidisciplinary education as result of formulated points of improvement from perinatal audit | 4 | Relevance round 2 | 1 | 3 | 1 | 17 | 20 | 42 | 6 | 90,5 | Include | ||||
Feasible round 2 | 1 | 5 | 3 | 16 | 16 | 1 | 42 | 6 | 83,3 | ||||||
Participation and representation of clients in organisation (i.e. in the board) | 7 | Relevance round 2 | 1 | 5 | 12 | 14 | 10 | 42 | 6 | 85,7 | Include | ||||
Feasible round 2 | 1 | 7 | 7 | 9 | 17 | 1 | 42 | 6 | 78,6 | ||||||
Rejected after round 2 | |||||||||||||||
Opportunities to stay in the birth centre after giving birth | 7 | Relevance round 1 | 2 | 2 | 4 | 15 | 9 | 11 | 6 | 49 | 5 | 71,4 | Submit again | ||
Feasible round 1 | 1 | 1 | 3 | 5 | 6 | 13 | 19 | 1 | 49 | 6 | 77,5 | ||||
Relevance round 2 | 2 | 4 | 5 | 7 | 10 | 9 | 5 | 42 | 5 | 61,9 | Reject | ||||
Feasible round 2 | 3 | 4 | 3 | 14 | 18 | 42 | 6 | 83,3 | |||||||
Legal entity (i.e. foundation, association) | 8 | Relevance round 1 | 2 | 2 | 5 | 16 | 7 | 8 | 4 | 5 | 49 | 4 | 57,2 | Submit again | |
Feasible round 1 | 1 | 1 | 8 | 2 | 10 | 21 | 6 | 49 | 6 | 67,4 | |||||
Relevance round 2 | 3 | 3 | 1 | 20 | 3 | 6 | 2 | 4 | 42 | 4 | 57,1 | Reject | |||
Feasible round 2 | 5 | 4 | 11 | 19 | 3 | 42 | 6 | 80.9 | |||||||
Independent supervisory board | 8 | Relevance round 1 | 2 | 2 | 2 | 7 | 6 | 13 | 13 | 3 | 48 | 6 | 66,7 | Submit again | |
Feasible round 1 | 2 | 2 | 7 | 3 | 12 | 20 | 2 | 48 | 6 | 73 | |||||
Relevance round 2 | 1 | 1 | 6 | 5 | 17 | 11 | 1 | 42 | 6 | 78,6 | Reject | ||||
Feasible round 2 | 1 | 7 | 2 | 17 | 14 | 1 | 42 | 6 | 78,6 | ||||||
Multidisciplinary composition of the board of the birth centre (e.g. midwives, maternity care organization and hospital) | 4 | Relevance round 1 | 3 | 1 | 2 | 4 | 10 | 11 | 17 | 48 | 6 | 79,1 | Submit again | ||
Feasible round 1 | 1 | 1 | 5 | 5 | 8 | 28 | 48 | 7 | 85,4 | ||||||
Relevance round 2 | 1 | 1 | 1 | 6 | 5 | 18 | 10 | 42 | 6 | 78,6 | Reject | ||||
Feasible round 2 | 3 | 2 | 9 | 28 | 42 | 7 | 92,7 | ||||||||
Publication of annual report | 8 | Relevance round 1 | 2 | 1 | 8 | 9 | 14 | 14 | 48 | 6 | 77,2 | Submit again | |||
Feasible round 1 | 2 | 4 | 2 | 14 | 25 | 2 | 49 | 7 | 85,5 | ||||||
Relevance round 2 | 1 | 8 | 7 | 14 | 12 | 42 | 6 | 78,6 | Reject | ||||||
Feasible round 2 | 6 | 7 | 28 | 1 | 42 | 7 | 83,4 | ||||||||
Number of births and postpartum stays that occur per year in the birth centre | 4 | Relevance | 2 | 2 | 2 | 6 | 7 | 13 | 16 | 48 | 6 | 75 | submit again | ||
Feasible | 1 | 2 | 5 | 15 | 25 | 48 | 7 | 93,8 | |||||||
Relevance round 2 | 2 | 1 | 6 | 5 | 21 | 7 | 42 | 6 | 78,6 | Reject | |||||
Feasible round 2 | 1 | 8 | 33 | 42 | 7 | 97,6 | |||||||||
Facilities at a birth centre in relation to stay (i.e. possibilities for father to stay overnight, private shower and/or toilet in room, bath) | 7 | Relevance round 1 | 2 | 4 | 4 | 10 | 13 | 16 | 49 | 6 | 79,6 | Submit again | |||
Feasible round 1 | 1 | 6 | 6 | 10 | 26 | 49 | 7 | 85,7 | |||||||
Relevance round 2 | 1 | 4 | 4 | 8 | 12 | 13 | 42 | 6 | 78,7 | Reject | |||||
Feasible round 2 | 1 | 1 | 4 | 8 | 27 | 1 | 42 | 7 | 92,8 | ||||||
24 h presence of a caregiver in birth centre (maternity care assistant or midwife) | 2 | Relevance round 2 | 3 | 3 | 2 | 4 | 4 | 13 | 12 | 1 | 42 | 6 | 69.1 | Reject | |
Feasible round 2 | 1 | 2 | 1 | 2 | 2 | 8 | 24 | 2 | 42 | 7 | 80,9 | ||||
Independent or freestanding setting with a home-like, non-clinical atmosphere | 6 | Relevance round 2 | 4 | 1 | 8 | 8 | 7 | 9 | 5 | 42 | 4,5 | 54,7 | Reject | ||
Feasible round 2 | 2 | 2 | 5 | 6 | 14 | 13 | 42 | 6 | 78,6 | ||||||
Detailed business plan for the birth centre | 4 | Relevance round 2 | 2 | 1 | 8 | 7 | 15 | 6 | 3 | 42 | 5,5 | 71,4 | Reject | ||
Feasible round 2 | 1 | 4 | 4 | 15 | 17 | 1 | 42 | 6 | 85,7 | ||||||
Participation of the birth centre in scientific research | 1 | Relevance round 2 | 1 | 3 | 10 | 14 | 6 | 7 | 1 | 42 | 5 | 71,4 | Reject | ||
Feasible round 2 | 1 | 7 | 8 | 12 | 13 | 1 | 42 | 6 | 78,6 | ||||||
Transfer from birthing room to a residence room when the mother of newly-born child wants/can/ has to stay a (part of her) childbed period; | 7 | Relevance round 2 | 2 | 3 | 1 | 14 | 6 | 8 | 2 | 6 | 42 | 4 | 50 | Reject | |
Feasible round 2 | 1 | 1 | 1 | 7 | 5 | 9 | 12 | 6 | 42 | 5,5 | 50 | ||||
Staff in the birth centre mirrors the population that (may) use the birth centre | 7 | Relevance round 2 | 9 | 3 | 4 | 13 | 4 | 3 | 2 | 4 | 42 | 4 | 50 | Reject | |
Feasible round 2 | 4 | 4 | 1 | 12 | 3 | 10 | 5 | 3 | 42 | 4 | 38,1 |