Current Dutch Practice on Caesarean Sections: Identification of Barriers and Facilitators for Optimal Care

NCT ID: NCT01261676

Last Updated: 2012-10-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

1000 participants

Study Classification

OBSERVATIONAL

Study Start Date

2010-12-31

Brief Summary

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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.

Detailed Description

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Conditions

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Caesarean Section

Keywords

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caesarean section labour, obstetric implementation guidelines quality indicators

Study Design

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Observational Model Type

CASE_CONTROL

Study Time Perspective

RETROSPECTIVE

Study Groups

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Caesarean section

Implementation aids

Intervention Type OTHER

An implementation strategy to improve outcome for women in labour will be developed depending on the outcome of the current care study and the barrier and facilitator analysis.The strategy will be executed and evaluated in a controlled before-and-after study in 12 hospitals (6 intervention, 6 control)

Vaginal birth (control)

Implementation aids

Intervention Type OTHER

An implementation strategy to improve outcome for women in labour will be developed depending on the outcome of the current care study and the barrier and facilitator analysis.The strategy will be executed and evaluated in a controlled before-and-after study in 12 hospitals (6 intervention, 6 control)

Interventions

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Implementation aids

An implementation strategy to improve outcome for women in labour will be developed depending on the outcome of the current care study and the barrier and facilitator analysis.The strategy will be executed and evaluated in a controlled before-and-after study in 12 hospitals (6 intervention, 6 control)

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* A previous caesarean section in a 3-4 month time period.

Exclusion Criteria

* Major congenital malformality
* Fetal death prior to onset of delivery
* Duration of pregnancy less than 24 weeks of gestation
Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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ZonMw: The Netherlands Organisation for Health Research and Development

OTHER

Sponsor Role collaborator

Maastricht University Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Hubertina CJ Scheepers, Ph.D.

Role: PRINCIPAL_INVESTIGATOR

Maastricht University Medical Center

Locations

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Ziekenhuisgroep Twente

Almelo, , Netherlands

Site Status

Flevo Ziekenhuis

Almere Stad, , Netherlands

Site Status

Meander Medisch Centrum

Amersfoort, , Netherlands

Site Status

Academisch Medisch Centrum

Amsterdam, , Netherlands

Site Status

Gelreziekenhuizen

Apeldoorn, , Netherlands

Site Status

Rijnstate Ziekenhuis

Arnhem, , Netherlands

Site Status

Ijsselland Ziekenhuis

Capelle Aan Den Ijjsel, , Netherlands

Site Status

Catharina-ziekenhuis

Eindhoven, , Netherlands

Site Status

University Medical Centre Groningen

Groningen, , Netherlands

Site Status

Röpcke-Zweers Ziekenhuis

Hardenberg, , Netherlands

Site Status

Atrium Medisch Centrum Parkstad

Heerlen, , Netherlands

Site Status

Elkerliek Ziekenhuis

Helmond, , Netherlands

Site Status

Tergooiziekenhuizen

Hilversum, , Netherlands

Site Status

Maastricht Universitair Medisch Centrum

Maastricht, , Netherlands

Site Status

Universitair Medisch Centrum St. Radboud

Nijmegen, , Netherlands

Site Status

Orbis Medisch Centrum

Sittard, , Netherlands

Site Status

Universitair Medisch Centrum Utrecht

Utrecht, , Netherlands

Site Status

Maxima Medisch Centrum

Veldhoven, , Netherlands

Site Status

Sint Jansgasthuis

Weert, , Netherlands

Site Status

Zaans Medisch Centrum

Zaandam, , Netherlands

Site Status

Countries

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Netherlands

References

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Melman S, Schoorel EN, Dirksen C, Kwee A, Smits L, de Boer F, Jonkers M, Woiski MD, Mol BW, Doornbos JP, Visser H, Huisjes AJ, Porath MM, Delemarre FM, Kuppens SM, Aardenburg R, Van Dooren IM, Vrouenraets FP, Lim FT, Kleiverda G, van der Salm PC, de Boer K, Sikkema MJ, Nijhuis JG, Hermens RP, Scheepers HC. SIMPLE: implementation of recommendations from international evidence-based guidelines on caesarean sections in the Netherlands. Protocol for a controlled before and after study. Implement Sci. 2013 Jan 3;8:3. doi: 10.1186/1748-5908-8-3.

Reference Type DERIVED
PMID: 23281646 (View on PubMed)

Other Identifiers

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17100.3006

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

09-4-047

Identifier Type: -

Identifier Source: org_study_id