title: Performance indicators for maternity care in a circumpolar context: a scoping review.
abstract: In circumpolar regions, harsh climates and scattered populations have prompted the centralization of care and reduction of local maternity services. The resulting practice of routine evacuation for birth from smaller towns to larger urban centres points to a potential conflict between the necessity to ensure patient safety and the importance of delivering services that are responsive to the health needs and values of populations served.
  
  
  
  To identify recommended performance/quality indicators for use in circumpolar maternity care systems.
  
  
  
  We searched Scopus, Ebscohost databases (including Academic Search Complete and CINAHL), the Global Health Database, High North Research Documents, and online grey literature. Articles were included if they focused on maternal health indicators in the population of interest (Indigenous women, women receiving care in circumpolar or remote regions). Articles were excluded if they were not related to pregnancy, birth or the immediate post-partum or neonatal periods. Two reviewers independently reviewed articles for inclusion and extracted relevant data.
  
  
  
  Twenty-six documents were included. Twelve were government documents, seven were review articles or indicator compilations, four were indicator sets recommended by academics or non-governmental organizations and three were research papers. We extracted and categorized 81 unique health indicators. The majority of indicators reflected health systems processes and outcomes during the antenatal and intra-partum periods. Only two governmental indicator sets explicitly considered the needs of Indigenous peoples.
  
  
  
  This review demonstrates that, although most circumpolar health systems engage in performance reporting for maternity care, efforts to capture local priorities and values are limited in most regions. Future work in this area should involve northern stakeholders in the process of indicator selection and development.
authors.affiliation: Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.|Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada; rebecca.rich@mail.utoronto.ca.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Rich
authors.affiliation: Institute for Circumpolar Health Research, Yellowknife, Canada.
authors.forename: Thomsen
authors.initials: T
authors.lastname: D'Hont
authors.affiliation: Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Canada.
authors.forename: Janice
authors.initials: J
authors.lastname: Linton
authors.affiliation: Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.|Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada.|Mount Sinai Hospital, Toronto, Canada.
authors.forename: Kellie E
authors.initials: KE
authors.lastname: Murphy
authors.affiliation: Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.|Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Veillard
authors.affiliation: Institute for Circumpolar Health Research, Yellowknife, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Chatwood
mesh_terms: D001110:Arctic Regions; D005260:Female; D006801:Humans; D004930:Inuit; D008427:Maternal Health Services / Q000592:standards*; D011247:Pregnancy; D019984:Quality Indicators, Health Care / Q000592:standards*
keywords: Indigenous; circumpolar; health; health care quality; indicator; performance measurement