OBSTETRIC CHARACTERISTICS PROFILES AS QUALITY ASSESSMENT OF OBSTETRIC CARE

In The Netherlands only about 50% of all pregnancies are defined as high risk pregnancies and consequently come into the domain of care of an obstetrician. In order to qualify as a high risk pregnancy, the pregnancy must satisfy certain criteria contained in an officially approved list of indications. Due to varying perceptions of these selection criteria by the selectors, larger differences in the treated population, obstetric interventions and results, respectively, were expected than in other countries. Within the framework of the project 'Obstetric Peer Review' (Verloskundige Onderlinge Kwaliteitsspiegeling, VOKS) the type and the magnitude of the differences of the values of the obstetric characteristics of population, interventions and results, respectively have been investigated. For the high risk pregnancies the data contained in the Perinatal Database of The Netherlands were used for the years 1983-1987, both inclusive. Because the various obstetric departments in The Netherlands had been unaware of these differences, consequently they had to become conscious about these differences and be informed about their own position relative to the others. For an instant comparison a single sheet graphical method has been designed, affording the assessment of one's own obstetric characteristics relative to those of other departments for the above mentioned 5 years for each of the 25 items considered. All departments, which participated in the Perinatal Database of The Netherlands during the years 1983-1987, received their own profiles and were invited to reply. Large differences were observed for the various characteristics considered. The departments themselves found the information about their values, relative to all other departments, nearly always useful, the response rate being 81%.