title: GerOSS (German Obstetric Surveillance System). A Project to Improve the Treatment of Obstetric Rare Diseases and Complications Using a Web Based Documentation and Information Platform.
abstract: BACKGROUND
  Severe and very rare obstetric complications (e.g. eclampsia, postpartum haemorrhage or uterine rupture), typically culminate in a chaotic, uncontrollable sequence of events. Outcome for mother and child depends on whether doctors and midwives are able to quickly take correct decisions and initiate optimal treatment.
  
  
  OBJECTIVE
  GerOSS (German Obstetric Surveillance System) aims at generating deeper insight into relevant risk factors to improve diagnosis and treatment of severe complications during pregnancy and delivery. As such it is primarily conceived as a system for quality improvement and less as a register. Another focus is the provision of an information and communication platform for dissemination of these insights. Finally, incidences of selected rare obstetric events may be derived.
  
  
  METHODS
  These rare events are monitored for two to five years in Lower Saxony, Bavaria and Berlin. Quantitative analyses of aggregate data are complemented with in depth case based anonymised evaluations by experts. The temporal sequence of measures taken as well as the management of care is inspected. Participants receive a feedback of comments on the synopsis of individual cases. Aggregate data results are published and made available through the GerOSS platform. A scientific advisory committee ensures the link with the professional scientific bodies. A comparison within INOSS (International Network of Obstetric Survey Systems) allows additional insights into the treatment of obstetric rare diseases and complications. More reliable estimates of the incidence of such events can be computed and compared within a larger database.
  
  
  RESULTS
  Following the implementation in three federal states in Germany in 2010, participation in GerOSS-Project has increased to 100% of all hospitals with a delivery unit in Lower Saxony, 30% in Bavaria and 80% in Berlin. Feasibility of the project is shown by successful implementation of GerOSS. Quantitative analyses enable construction of risk profiles (e.g. for the prevalence of hysterectomies and uterine ruptures) such that tailored treatment algorithms may be derived. Age, body mass index and previous caesarean section are common risk factors when complications occur. Respective recommendations have not always been adhered to in the diagnosis and therapy of such cases. The presentation of initial GerOSS results has paved the path for first changes in obstetric care.
  
  
  CONCLUSIONS
  The envisaged expansion of GerOSS to an interactive platform will allow dissemination of insights such that optimal obstetric care and transferal among all involved medical facilities may see future enhancements via the internet or even through smartphone applications.
authors.affiliation: Silvia Berlage, Centre for Quality and Management in Health Care (ZQ), Institution of the Lower Saxony Medical Chamber, Berliner Allee 20, 30175 Hannover, Germany, E-mail: silvia.berlage@aekn.de.
authors.forename: S
authors.initials: S
authors.lastname: Berlage
authors.forename: S
authors.initials: S
authors.lastname: Grüßner
authors.forename: N
authors.initials: N
authors.lastname: Lack
authors.forename: H B G
authors.initials: HB
authors.lastname: Franz
mesh_terms: D000293:Adolescent; D000328:Adult; D003628:Database Management Systems; D004282:Documentation / Q000379:methods / Q000706:statistics & numerical data*; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D020407:Internet / Q000706:statistics & numerical data*; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D058996:Quality Improvement / Q000706:statistics & numerical data*; D035583:Rare Diseases; D012307:Risk Factors; D055815:Young Adult
keywords: Delivery; health care surveys; health information system; management information systems; obstetric labour complications; patient safety; quality of health care; sentinel surveillance