title: Guideline-based development of quality indicators for prevention and management of postpartum hemorrhage.
abstract: BACKGROUND
  To systematically develop a set of guideline-based quality indicators for postpartum hemorrhage (PPH) as a tool to measure guideline adherence in actual PPH care.
  
  
  METHODS
  A Rand-modified Delphi procedure was used to systematically achieve consensus among a panel of 22 experts on PPH care on recommendations extracted from evidence-based guidelines, Managing-Obstetrics-Emergencies-Trauma (MOET) instructions and international literature. The selected recommendations were individually rated on health gain (prevention of maternal mortality and morbidity) and overall efficiency by the expert panel. Subsequently, consensus about the most important recommendations to measure quality of PPH care among the panel members was reached, followed by a final approval. Last, definition of the final set by critical appraisal of the recommendations regarding measurability took place. The main outcome measure was a set of valid quality indicators for prevention and management of PPH.
  
  
  RESULTS
  From the 69 extracted recommendations, 50 were selected and translated into 22 quality indicators on professional performance (n = 17) and organization of PPH care (n = 5). The professional performance indicators covered all fields of PPH care, such as prevention (n = 2) and management of PPH, including communication and documentation (n = 4), monitoring and prevention of shock (n = 3), use of blood products (n = 3) and treatment of PPH (n = 5). Organizational indicators (n = 5) were clustered into protocols and agreements, audit, accessibility and documentation.
  
  
  CONCLUSIONS
  This study describes a stepwise systematic development of 22 performance and organizational indicators to use for measuring the whole care process of prevention and management of PPH.
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Mallory D
authors.initials: MD
authors.lastname: Woiski
authors.affiliation: Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Hubertina C
authors.initials: HC
authors.lastname: Scheepers
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Janine
authors.initials: J
authors.lastname: Liefers
authors.affiliation: Department of Anesthesiology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Marcus
authors.initials: M
authors.lastname: Lance
authors.affiliation: Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Middeldorp
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Fred K
authors.initials: FK
authors.lastname: Lotgering
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Grol
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Rosella P
authors.initials: RP
authors.lastname: Hermens
mesh_terms: D061906:Advanced Trauma Life Support Care; D003697:Delphi Technique; D005260:Female; D006801:Humans; D006473:Postpartum Hemorrhage / Q000517:prevention & control / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D019984:Quality Indicators, Health Care
keywords: Postpartum hemorrhage; access; evaluation; guideline adherence; health care quality; healthcare quality indicators; pregnancy complication