title: Feasibility and reliability of a newly developed antenatal risk score card in routine care.
abstract: OBJECTIVE
  to study in routine care the feasibility and inter-rater reliability of the Rotterdam Reproductive Risk Reduction risk score card (R4U), a new semi-quantitative score card for use during the antenatal booking visit. The R4U covers clinical and non-clinical psychosocial factors and identifies overall high risk pregnancies, qualifying for intensified antenatal care.
  
  
  METHODS
  a population-based cross-sectional study (feasibility) and a cohort study (inter-rater reliability).
  
  
  METHODS
  feasibility was studied in six midwifery practices and two hospitals; the reliability study was performed in one midwifery practice.
  
  
  METHODS
  1096 pregnant women in the feasibility study and a subsample of 133 participants in the inter-rater reliability study.
  
  
  METHODS
  feasibility was expressed as (a) time needed to complete the R4U and (b) the missing rate at the item and client level. For inter-rater reliability (IRR) an independent, blinded, caregiver completed a re-test R4U during a second visit; inter-rater agreement for each item and all domain sum scores were computed.
  
  
  RESULTS
  completion of the R4U took 5 minutes or less in 63%; and between 5 and 10 minutes in another 33%. On the participant level 0.2% of women had >20% missing values (below 4% threshold, P<0.001). One of 77 items had a >10% missing rate. The per item IRR was 100% in 20% of the items, and below the predefined 80% threshold in 13% of the items (n=9). The domain sum scores universally differed less than the predetermined ±15% margin.
  
  
  CONCLUSIONS
  the R4U risk score card is a feasible and reliable instrument.
  
  
  CONCLUSIONS
  the R4U is suitable for the assessment of clinical and non-clinical risks during the antenatal booking visit in a heterogeneous urban setting in routine practice.
authors.affiliation: Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Rotterdam, The Netherlands. Electronic address: m.j.van.veen@hr.nl.
authors.forename: Mieke J
authors.initials: MJ
authors.lastname: van Veen
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, The Netherlands.
authors.forename: Erwin
authors.initials: E
authors.lastname: Birnie
authors.affiliation: Weill Cornell Medical College, Department of Public Health, Division of Biostatistics and Epidemiology, New York, USA.
authors.forename: Jashvant
authors.initials: J
authors.lastname: Poeran
authors.affiliation: Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Rotterdam, The Netherlands.
authors.forename: Hanneke W
authors.initials: HW
authors.lastname: Torij
authors.affiliation: Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, The Netherlands.
authors.forename: Eric A P
authors.initials: EA
authors.lastname: Steegers
authors.affiliation: Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, The Netherlands; Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, The Netherlands.
authors.forename: Gouke J
authors.initials: GJ
authors.lastname: Bonsel
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008880:Midwifery / Q000379:methods* / Q000592:standards; D011247:Pregnancy; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult
keywords: Antenatal risk assessment; Feasibility; Reliability