Early Postnatal Discharge in a French Perinatal Network

NCT ID: NCT02298569

Last Updated: 2016-03-24

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

Clinical Phase

NA

Total Enrollment

800 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-09-30

Study Completion Date

2017-04-30

Brief Summary

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The purpose of this "before-after" study is to determine the effectiveness of a multidimensional intervention to increase the rate for early discharge of low-risk mothers and the healthy newborn in a perinatal network.

Detailed Description

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In March 2014, the French Health Authorities edited new guidelines about early discharge after delivery. Early discharge is defined as a discharge during the 72 hours following vaginal delivery of low-risk mothers and their healthy newborn. These guidelines defined the conditions of eligibility for early discharge for mothers and babies, and the different criteria of their follow-up at home by midwives .

The average length of stay following normal delivery is higher in France than in other European countries: eg : 4.3 days in France vs 2.2 days in Sweden (OECD indicators 2011) On the other hand, according to an investigation conducted by a patients association, 38% women declared that they felt that their hospitalization was too long after their baby's birth, but their request for a shorter stay had not been taken into account by hospital caregivers. The investigators hypothesis is that the rate of early discharge could be increased by a multi-pronged program coordinated in a perinatal network, and could improve quality of postpartum care, and women's satisfaction.

The "Réseau Périnatal Alpes Isère" is a perinatal network located in French Alps region. Its purpose is to coordinate 5 maternity services an organization of midwives providing pre and postnatal home care, for about 10000 births annually. In 2010, according to the hospital database provided by the Medical Information Systems Program, early discharge concerned only 4.1% of mothers between 0 and 48 hours after delivery . At the same time, 65% of women could be considered as at low risk, considering they gave birth to a healthy singleton, born after 38 weeks of gestation by vaginal delivery. This rate is not precise, in view of the lack of availability of documented rate of non-eligibility for early discharge such as non- eutrophic babies, or adverse events during postpartum and the neonatal period.

Conditions

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Pregnancy Complications Nos Labor/Delivery Problems Nos Vitality; Newborn

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Phase 1 (before multi-pronged program)

400 low-risk mothers having given birth without any complication to a healthy newborn are to be recruited in the 5 maternity wards of a French perinatal network consecutively, whatever the duration of their hospital stay

Group Type NO_INTERVENTION

No interventions assigned to this group

Phase 2 (after multi-pronged program)

400 low-risk mothers having given birth without any complication to a healthy newborn are to be recruited in the 5 maternity wards of the same French perinatal network 3 months after the intervention (introduction of the multi-pronged program) consecutively, whatever the duration of their hospital stay

Group Type EXPERIMENTAL

multi-pronged program to improve early postpartum discharge

Intervention Type BEHAVIORAL

Better team integration and changes to promote interprofessional collaboration and communication between healthcare providers involved in pre- and post-natal care in a perinatal network.

Transition optimization: all involved healthcare professionals will complete a specific form during pregnancy and hospitalization to coordinate support safe process, and to improve quality transitions to outpatient midwives and pediatrician. A check-list will be completed by the mother to assess whether she agrees to early discharge and that she is aware of its conditions Implementation of best practices about early discharge after delivery to improve safety of early discharge particularly for neonates at risk (jaundice and dehydration).

Interventions

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multi-pronged program to improve early postpartum discharge

Better team integration and changes to promote interprofessional collaboration and communication between healthcare providers involved in pre- and post-natal care in a perinatal network.

Transition optimization: all involved healthcare professionals will complete a specific form during pregnancy and hospitalization to coordinate support safe process, and to improve quality transitions to outpatient midwives and pediatrician. A check-list will be completed by the mother to assess whether she agrees to early discharge and that she is aware of its conditions Implementation of best practices about early discharge after delivery to improve safety of early discharge particularly for neonates at risk (jaundice and dehydration).

Intervention Type BEHAVIORAL

Other Intervention Names

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team integration and culture change transition optimisations implementation of best practices

Eligibility Criteria

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Inclusion Criteria

"1" low risk mothers ith uncomplicated pregnancy and birth defined as

* lack of mental disability
* lack of referred problems about mother to infant bonding
* lack of precarious state
* vaginal delivery without bleeding more than 500cc
* lack of postpartum complications during hospitalization

"2" low risk baby defined as

* singleton
* gestational age \>= 38 weeks
* apgar score \> 7 at 5 minutes life
* normal weight expected for gestational age
* lack of infection, or jaundice

Exclusion Criteria

* person deprived of liberty
* person who does not speak French
* person not covered by health insurance
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Réseau Périnatal Alpes-Isere

UNKNOWN

Sponsor Role collaborator

University Hospital, Grenoble

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Claudine MARTIN

Role: PRINCIPAL_INVESTIGATOR

RPAI (Réseau Périnatal Alpes Isere), CHU Grenoble

Locations

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Clinique des Cèdres

Échirolles, , France

Site Status

Clinique Mutualiste

Grenoble, , France

Site Status

Hopital Couple Enfant

La Tronche, , France

Site Status

Clinique Belledonne

Saint-Martin-d'Hères, , France

Site Status

CH Voiron

Voiron, , France

Site Status

Countries

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France

References

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Liu S. Rate of neonatal hospital readmission after discharge following birth. Canadian Perinatal Health Report 2003; 104-106. http://www.hc-sc.gc.ca/pphb-dgspsp/rhs-ssg/index.html

Reference Type BACKGROUND

Ellberg L, Hogberg U, Lundman B, Kallen K, Hakansson S, Lindh V. Maternity care options influence readmission of newborns. Acta Paediatr. 2008 May;97(5):579-83. doi: 10.1111/j.1651-2227.2008.00714.x.

Reference Type BACKGROUND
PMID: 18394103 (View on PubMed)

Radmacher P, Massey C, Adamkin D. Hidden morbidity with "successful"early discharge.J Perinatol.2002;22:15-20 VIBoulvain M, Perneger TV, Othenin-Girard V, PetrouS, Berner M, Irion O. Home-based versus hospital-based postnatal care:arandomisedtrial.BJOG: an International Journal of Obstetrics and Gynaecology 2004; 111: 807-813.

Reference Type BACKGROUND

Oddie SJ, Hammal D, Richmond S, Parker L. Early discharge and readmission to hospital in the first month of life in the Northern Region of the UK during 1998: a case cohort study. Arch Dis Child. 2005 Feb;90(2):119-24. doi: 10.1136/adc.2003.040766.

Reference Type BACKGROUND
PMID: 15665161 (View on PubMed)

Sainz Bueno JA, Romano MR, Teruel RG, Benjumea AG, Palacin AF, Gonzalez CA, Manzano MC. Early discharge from obstetrics-pediatrics at the Hospital de Valme, with domiciliary follow-up. Am J Obstet Gynecol. 2005 Sep;193(3 Pt 1):714-26. doi: 10.1016/j.ajog.2005.01.015.

Reference Type BACKGROUND
PMID: 16150265 (View on PubMed)

Johansson K, Aarts C, Darj E. First-time parents' experiences of home-based postnatal care in Sweden. Ups J Med Sci. 2010 May;115(2):131-7. doi: 10.3109/03009730903431809.

Reference Type BACKGROUND
PMID: 20074000 (View on PubMed)

Shaw E, Levitt C, Wong S, Kaczorowski J; McMaster University Postpartum Research Group. Systematic review of the literature on postpartum care: effectiveness of postpartum support to improve maternal parenting, mental health, quality of life, and physical health. Birth. 2006 Sep;33(3):210-20. doi: 10.1111/j.1523-536X.2006.00106.x.

Reference Type BACKGROUND
PMID: 16948721 (View on PubMed)

Bravo P, Uribe C, Contreras A. Early postnatal hospital discharge: the consequences of reducing length of stay for women and newborns. Rev Esc Enferm USP. 2011 Jun;45(3):758-63. doi: 10.1590/s0080-62342011000300030.

Reference Type BACKGROUND
PMID: 21710086 (View on PubMed)

http://www.sante.gouv.fr/IMG/pdf/Les_naissances_en_2010_et_leur_evolution_depuis_2003.pdf

Reference Type BACKGROUND

OCDE (2009), Panorama de la santé 2009 : Les indicateurs de l'OCDE, Éditions OCDE.doi : 10.1787/health_glance-2009-fr

Reference Type BACKGROUND

Smith LF. Postnatal care: development of a psychometric multidimensional satisfaction questionnaire (the WOMBPNSQ) to assess women's views. Br J Gen Pract. 2011 Oct;61(591):e628-37. doi: 10.3399/bjgp11X601334.

Reference Type BACKGROUND
PMID: 22152835 (View on PubMed)

Antoniotti S, Baumstarck-Barrau K, Simeoni MC, Sapin C, Labarere J, Gerbaud L, Boyer L, Colin C, Francois P, Auquier P. Validation of a French hospitalized patients' satisfaction questionnaire: the QSH-45. Int J Qual Health Care. 2009 Aug;21(4):243-52. doi: 10.1093/intqhc/mzp021. Epub 2009 Jun 23.

Reference Type BACKGROUND
PMID: 19549673 (View on PubMed)

Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, Bullinger M, Kaasa S, Leplege A, Prieto L, Sullivan M. Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol. 1998 Nov;51(11):1171-8. doi: 10.1016/s0895-4356(98)00109-7.

Reference Type BACKGROUND
PMID: 9817135 (View on PubMed)

Edinburgh Depression Scale Translated Government of Western Australia Department of Health www.folkhalsoguiden.se/upload/Psykisk Hälsa/Edinburgh Depression Scale Translated Government of Western Australia Department of Health.pdf

Reference Type BACKGROUND

DOMECQ, S. AUSTRUY, J.VIOT, F. CADIOT, C POURIN. Evaluation de la satisfaction des correspondants externes : Rapport régional, mars 2009. CCECQA -Hôpital Xavier Arnozan -33604 Pessac www.ccecqa.asso.fr

Reference Type BACKGROUND

Other Identifiers

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DCIC 13 17

Identifier Type: -

Identifier Source: org_study_id

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