Table 4 Recommendations for promoting the integration of research evidence into Canadian prenatal records

1) Ensure the involvement of multiple stakeholders in the development and review of prenatal records and in final decision-making about revisions to these forms. All disciplines that provide prenatal care should be represented to provide essential input on feasibility.

Prenatal record forms serve the needs of diverse disciplines in addition to prenatal care providers with differing levels of skill (e.g., residents, rural practitioners with few pregnant patients). PRCs benefited from participation and feedback of a broad range of stakeholders, either through direct involvement on the review committees, consultation/feedback from stakeholders throughout the revision process, or piloting of the record prior to its finalization. Key stakeholders may include representation from a variety of clinical disciplines; members with expertise in electronic records/data management/health surveillance; research/methodology experts to support the formal evaluation and application of research evidence; population health experts to ensure that population health needs are taken into account when revisions are considered; patients/consumers for ensuring acceptability and relevance of prenatal record content; and health economists/policy-makers to address health system resources needed for the delivery of evidence-based prenatal care.

2) Adopt formalized and explicit use of decision-support tools, decision-making processes and consensus approaches for the introduction, interpretation and application of research evidence in the development and revision of prenatal records.

A thorough, non-biased review of the research evidence requires access to the extant literature requires, technical expertise and sufficient time. PRCs need to be appropriately resourced to support the participation of all relevant stakeholders in the review process. More formalized consensus procedures would make the prenatal record review process more transparent and help to enhance the process of record revision by:

1) ensuring that the opinions of less “powerful” or vocal committee members are given equal consideration;

2) making explicit what should be done in cases where research evidence and pragmatic clinical or health surveillance considerations are at odds;

3) providing a formalized mechanism for decision-making about issues for which the research evidence is equivocal.

3) Consider both clinical and surveillance functions of the prenatal record form and appropriately use evidence to support both functions.

Different types and sources of evidence and evidence synthesis approaches are required for these two complementary data collection functions of the forms, including: risk factor etiology, effectiveness of assessment strategies to identify risk factors, effectiveness of interventions to address risk factors and alternative approaches to enhance/support clinical providers, and population health implications of not addressing a risk factor. Prenatal record committee composition needs to reflect these complementary but distinctive core functions of the form. Prenatal record data standards need to be aligned with national surveillance and existing perinatal health indicators.

4) Develop an evidence-based, national template for a prenatal record, to facilitate/promote adoption of optimal standards of evidence-based prenatal care across Canada.

A national prenatal form template that reflects best research evidence would help decrease unnecessary duplication of work across prenatal record committees in different Canadian jurisdictions; support consistent prenatal care when patients move across jurisdictions; and elicit more uniform data for a national perinatal surveillance system. A national template should be available in a flexible format that can be adapted/tailored to the particular needs and context within each jurisdiction. Development of a national template should involve representatives from all Canadian jurisdictions and key stakeholder organizations.

5) Plan and adequately resource comprehensive, effective and tailored strategies for dissemination of prenatal record modifications (e.g., outreach education; development of supporting guides to describe and provide a rationale for changes to the forms).

Insufficient support to busy clinicians using the revised prenatal record forms may contribute to provider frustration, dissatisfaction with the revised forms, and lack of compliance with completion of the forms. Disseminating revised prenatal record forms along with a guiding document that clearly points out all changes and their rationale was an important strategy used by many jurisdictions.