title: Guidelines-based indicators to measure quality of antenatal care.
abstract: OBJECTIVE
  No comprehensive measurement of quality of antenatal care is available. Late booking or low number of checks are often used as surrogate for poor quality, leaving uncertainty on the actual content of the care received. In order to fill this gap, we have reviewed two sets of clinical guidelines and developed corresponding indicators of quality.
  
  
  METHODS
  A group of clinicians and methodologists reviewed the National Institute for Clinical Excellency Clinical Guidelines on antenatal care, and the list of prenatal care interventions recommended by the Research and Development Group, both based on evidence of effectiveness of specific interventions. We identified single aspects in three domains: (1) services utilization; (2) screening; and (3) interventions. For each indicator, we defined: (1) eligibility, that is the characteristics of the women to whom the indicator applies; (2) standard, that is the situation when the target is met; and (3) moderators, that is all conditions which legitimately hamper the fulfilment of the standard.
  
  
  RESULTS
  We developed four indicators of service utilization, 25 of screening and 17 of intervention. The respective eligibility, standard and moderators criteria were described for each indicator. While many indicators could be retrospectively evaluated from medical charts, quality of communication with provider, screening for sensible issues and counselling on behaviours to be avoided could only be obtained with a prospective data collection.
  
  
  CONCLUSIONS
  The indicators of quality of antenatal care, complemented by measures of social position, social support and immigrant/ethnic status, allow for a careful description of the gaps in quality of care for specific groups of women.
authors.affiliation: Services for Medical Research, Evolène, Switzerland.
authors.forename: Paola
authors.initials: P
authors.lastname: Bollini
authors.forename: Katharina
authors.initials: K
authors.lastname: Quack-Lötscher
mesh_terms: D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D008403:Mass Screening; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards* / Q000706:statistics & numerical data*; D011296:Prenatal Diagnosis; D019984:Quality Indicators, Health Care; D012944:Social Support; D012959:Socioeconomic Factors; D013557:Switzerland
keywords: antenatal care; evidence-based guidelines; indicators; migrants and ethnic minorities; quality of care; vulnerable groups