title: National perinatal audit, a feasible initiative for the Netherlands!? A validation study.
abstract: OBJECTIVE
  To explore the feasibility of a national perinatal audit organization.
  
  
  METHODS
  Validation study.
  
  
  METHODS
  Three regions in the Netherlands.
  
  
  METHODS
  228 cases of perinatal mortality.
  
  
  METHODS
  Narratives of perinatal mortality cases were assessed by a panel of representatives of all perinatal care provider groups. 123 cases were assessed twice. Consensus was defined as 75% agreement. For the chance corrected agreement Cohen's kappa statistic was used.
  
  
  METHODS
  Consensus and the chance corrected agreement on three cause of death classifications. The presence or absence of substandard factors (SSF) with the care provider, the organization of care and the relation of the SSF with perinatal death.
  
  
  RESULTS
  Consensus rates and chance corrected agreement for three cause of death classifications ranged from 92 to 96% and kappa 0.87 to kappa 0.93 (very good agreement), with comparable confidence intervals and similar values in the validation subset of 123 cases. On the presence of SSF at the level of the care provider consensus and chance corrected agreement was 68% and kappa 0.53 (moderate), with comparable values in the subset of 123 cases. Consensus for the relation between SSF at the level of the care provider and perinatal death was 81.4% and kappa 0.68 (good).
  
  
  CONCLUSIONS
  Perinatal audit on a national level with relatively large audit groups with many different care providers is feasible.
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Center Groningen, Netherlands. m.t.van.diem@og.umcg.nl
authors.forename: Mariet
authors.initials: M
authors.lastname: van Diem
authors.forename: Paul
authors.initials: P
authors.lastname: De Reu
authors.forename: Martine
authors.initials: M
authors.lastname: Eskes
authors.forename: Hens
authors.initials: H
authors.lastname: Brouwers
authors.forename: Cas
authors.initials: C
authors.lastname: Holleboom
authors.forename: Tineke
authors.initials: T
authors.lastname: Slagter-Roukema
authors.forename: Hans
authors.initials: H
authors.lastname: Merkus
mesh_terms: D002423:Cause of Death; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008485:Medical Audit; D009426:Netherlands; D018743:Perinatal Care / Q000592:standards*; D054238:Perinatal Mortality; D011247:Pregnancy; D011787:Quality of Health Care