title: Adverse outcomes of (post-)term births and differences in professional organisational contexts: an integral descriptive system approach.
abstract: OBJECTIVE
  The development and application of an integral descriptive model for monitoring and evaluation of patient flows and adverse outcomes of childbirth related to distinct categories of professional organisational contexts.
  
  
  METHODS
  After categorisation of the individual professional contexts in which deliveries take place, the resulting framework has been superimposed on the 2002-2010 database of the Netherlands Perinatal Registry.
  
  
  METHODS
  All Dutch hospitals and almost all first-line midwife practices recorded 1,469,955 (post-)term births from which only the patients with a spontaneous onset of labour (n=1,120,508) were included in a study on the quality of obstetric care outside office hours.
  
  
  METHODS
  For the performance of professional organisational contexts the difference in relative incidence of perinatal death or Apgar score <7 between the related patient groups and the reference patient groups has been used. These differences have been expressed as risk ratio (RR) with a 95% CI.
  
  
  RESULTS
  Only the group of patients who started labour spontaneously under the supervision of the first-line midwife shows a proportional distribution over the parts of the day. In all other groups the distribution of patients is disproportional. The perinatal mortality rate declines by about 30% in the successive periods. This decline concerns mainly those patients who gave birth outside office hours.
  
  
  CONCLUSIONS
  The complexity and the dynamics of the obstetric care system make it virtually impossible to demonstrate fixed patterns in the relationships between the separate contextual factors and the (adverse) outcomes of births. To generate useful knowledge, it is necessary to evaluate changes in the obstetric care system periodically and systematically. Thus, the longitudinal application of the model demonstrated that the differences in perinatal mortality rate between the parts of the day have disappeared in recent years.
authors.affiliation: Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, The Netherlands.
authors.forename: Loes
authors.initials: L
authors.lastname: Harmsen
authors.affiliation: Independent Researcher and Management Consultant, JHS Healthcare, Tilburg, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Schaaf
mesh_terms: D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006739:Hospital Administration / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D007233:Infant, Postmature; D008297:Male; D008880:Midwifery / Q000458:organization & administration* / Q000706:statistics & numerical data*; D009426:Netherlands / Q000453:epidemiology; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*