title: Measuring the best outcome for the least intervention: can the Optimality Index-US be applied in the UK?
abstract: OBJECTIVE
  to pilot the Optimality Index-US (OI-US) for the first time within a UK maternity setting in a sample of women at mixed risk.
  
  
  METHODS
  a multidisciplinary group reviewed the items and evidence base of the OI-US. A pilot study was undertaken to compare the availability and quality of data from maternity records to complete the OI-US. Data were collected from maternity records.
  
  
  METHODS
  a maternity unit of an inner city teaching hospital in England.
  
  
  METHODS
  clinical midwives, research midwives, midwifery lecturers and consultant obstetricians (n=10) reviewed the items and evidence base of the OI-US. Data were collected from the maternity records of 97 women receiving caseload care and 103 women receiving standard care.
  
  
  RESULTS
  when the multidisciplinary group reviewed the items and evidence base of the OI-US, it was noted that some social and clinical factors should be considered for inclusion as part of the Perinatal Background Index (PBI) and OI. The results suggest that the inclusion of women at higher risk in this sample within the UK maternity setting has not been captured by the OI-US.
  
  
  CONCLUSIONS
  the following social and clinical factors should be included as part of the PBI and OI for the UK setting: measure of social deprivation, woman's ability to speak and understand English in relation to accessing maternity care, mental health problems during pregnancy and history of domestic violence during pregnancy
  
  
  CONCLUSIONS
  availability of items in electronic records is poor and it is recommended that the OI-UK version is a useful research tool in prospective data collection. The development of an international version would be valuable for comparison of background risk and outcomes across a range of care settings.
authors.affiliation: King's College London, Florence Nightingale School of Nursing and Midwifery, London SE1 8WA, UK. mary.2.sheridan@kcl.ac.uk
authors.forename: Mary
authors.initials: M
authors.lastname: Sheridan
authors.forename: Jane
authors.initials: J
authors.lastname: Sandall
mesh_terms: D019985:Benchmarking / Q000458:organization & administration; D015400:Clinical Nursing Research; D004739:England; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration*; D008880:Midwifery / Q000458:organization & administration*; D009721:Nurse Midwives / Q000458:organization & administration; D024802:Nurse's Role; D015403:Nursing Evaluation Research; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration*; D018743:Perinatal Care / Q000458:organization & administration; D010865:Pilot Projects; D011247:Pregnancy; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care / Q000458:organization & administration*; D017749:Total Quality Management