title: SIMPLE: implementation of recommendations from international evidence-based guidelines on caesarean sections in the Netherlands. Protocol for a controlled before and after study.
abstract: BACKGROUND
  Caesarean section (CS) rates are rising worldwide. In the Netherlands, the most significant rise is observed in healthy women with a singleton in vertex position between 37 and 42 weeks gestation, whereas it is doubtful whether an improved outcome for the mother or her child was obtained. It can be hypothesized that evidence-based guidelines on CS are not implemented sufficiently. Therefore, the present study has the following objectives: to develop quality indicators on the decision to perform a CS based on key recommendations from national and international guidelines; to use the quality indicators in order to gain insight into actual adherence of Dutch gynaecologists to guideline recommendations on the performance of a CS; to explore barriers and facilitators that have a direct effect on guideline application regarding CS; and to develop, execute, and evaluate a strategy in order to reduce the CS incidence for a similar neonatal outcome (based on the information gathered in the second and third objectives).
  
  
  METHODS
  An independent expert panel of Dutch gynaecologists and midwives will develop a set of quality indicators on the decision to perform a CS. These indicators will be used to measure current care in 20 hospitals with a population of 1,000 women who delivered by CS, and a random selection of 1,000 women who delivered vaginally in the same period. Furthermore, by interviewing healthcare professionals and patients, the barriers and facilitators that may influence the decision to perform a CS will be measured. Based on the results, a tailor-made implementation strategy will be developed and tested in a controlled before-and-after study in 12 hospitals (six intervention, six control hospitals) with regard to effectiveness, experiences, and costs.
  
  
  CONCLUSIONS
  This study will offer insight into the current CS care and into the hindering and facilitating factors influencing obstetrical policy on CS. Furthermore, it will allow definition of patient categories or situations in which a tailor-made implementation strategy will most likely be meaningful and cost effective, without negatively affecting the outcome for mother and child.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov: NCT01261676.
authors.affiliation: GROW-School for Oncology and Developmental Biology, Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands. s.melman@mumc.nl
authors.forename: Sonja
authors.initials: S
authors.lastname: Melman
authors.forename: Ellen N C
authors.initials: EN
authors.lastname: Schoorel
authors.forename: Carmen
authors.initials: C
authors.lastname: Dirksen
authors.forename: Anneke
authors.initials: A
authors.lastname: Kwee
authors.forename: Luc
authors.initials: L
authors.lastname: Smits
authors.forename: Froukje
authors.initials: F
authors.lastname: de Boer
authors.forename: Madelaine
authors.initials: M
authors.lastname: Jonkers
authors.forename: Mallory D
authors.initials: MD
authors.lastname: Woiski
authors.forename: Ben Willem J
authors.initials: BW
authors.lastname: Mol
authors.forename: Johannes P R
authors.initials: JP
authors.lastname: Doornbos
authors.forename: Harry
authors.initials: H
authors.lastname: Visser
authors.forename: Anjoke J M
authors.initials: AJ
authors.lastname: Huisjes
authors.forename: Martina M
authors.initials: MM
authors.lastname: Porath
authors.forename: Friso M C
authors.initials: FM
authors.lastname: Delemarre
authors.forename: Simone M I
authors.initials: SM
authors.lastname: Kuppens
authors.forename: Robert
authors.initials: R
authors.lastname: Aardenburg
authors.forename: Ivo M A
authors.initials: IM
authors.lastname: Van Dooren
authors.forename: Francis P J M
authors.initials: FP
authors.lastname: Vrouenraets
authors.forename: Frans T H
authors.initials: FT
authors.lastname: Lim
authors.forename: Gunilla
authors.initials: G
authors.lastname: Kleiverda
authors.forename: Paulien C M
authors.initials: PC
authors.lastname: van der Salm
authors.forename: Karin
authors.initials: K
authors.lastname: de Boer
authors.forename: Marko J
authors.initials: MJ
authors.lastname: Sikkema
authors.forename: Jan G
authors.initials: JG
authors.lastname: Nijhuis
authors.forename: Rosella P M G
authors.initials: RP
authors.lastname: Hermens
authors.forename: Hubertina C J
authors.initials: HC
authors.lastname: Scheepers
mesh_terms: D002585:Cesarean Section / Q000191:economics / Q000706:statistics & numerical data*; D002985:Clinical Protocols; D003365:Costs and Cost Analysis; D003657:Decision Making; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006176:Gynecology / Q000191:economics / Q000592:standards; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000592:standards; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics / Q000601:surgery*; D011295:Prenatal Care / Q000191:economics / Q000592:standards; D019984:Quality Indicators, Health Care; D019564:Unnecessary Procedures / Q000706:statistics & numerical data