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Table 1 Selected determinants per domain

From: Developing quality indicators for assessing quality of birth centre care: a mixed- methods study

Determinant

Type of indicator

Rating on:

Median score Likert scale

Consensus (%)

Conclusion round 1

Conclusion round 2

(1–7)

(80% consensus)

(80% consensus)

Domain: effectiveness

 Written agreements on care aspects (i.e. by hospital care, obstetricians)

Structure

Relevance

7

100

Include

 

Feasible

6

87,5

 

 Structural evaluation of the care provided in the birth centre

Structure

Relevance

7

93,7

Include

 

Feasible

6

83,4

 

 Maternity care assistant present during laboura

Process

Relevance

6

87,5

Include

 

Feasible

6,5

79,2

 

 (Integrated) ICT system with hospital and midwifery practices

Structure

Relevance round 1

6

75

Submit again

 

Feasible round 1

5

54,3

Relevance round 2

6

90,5

 

Include

Feasible round 2

6

76,2

Domain: safety

 Facilities at a birth centre in relation to emergency care (i.e. CPR resuscitation)

Structure

Relevance

7

95,9

Include

 

Feasible

7

97,9

 

 Joint (interdisciplinary) emergency care training

Process

Relevance

6

95,8

Include

 

Feasible

6

87,5

 

 Agreements with ambulance service and nearest hospital about urgent referrals

Structure

Relevance

7

89,6

Include

 

Feasible

6

77

 

Domain: timeliness

 Necessary transport time from birth centre to hospital

Process

Relevance

7

100

Include

 

Feasible

7

96

 

 In case of referral from the birth centre durante partu: required time between decision to refer and treatment in hospital

Process

Relevance

7

95,9

Include

 

Feasible

6

81,3

 

Domain: efficiency

 In case of referral from the birth centre durante partu: guaranteed access to the hospital with which agreements were made

Process

Relevance

7

100

Include

 

Feasible

6

87,6

 

 Distance between birth centre and hospital

Structure

Relevance

7

98

Include

 

Feasible

7

96

 

 Cooperation with (almost) all relevant organizations in the region (such as midwifery practices and maternity care assistance organisations)

Process

Relevance

6

89,5

Include

 

Feasible

6

81,3

 

 Protocols on care aspects

Structure

Relevance

7

87,5

Include

 

Feasible

6,5

81,3

 

 Participation of birth centre in local maternity care consultation and cooperation group (VSV)

Process

Relevance

7

85,4

Include

 

Feasible

6

81,3

 

 Indoor connection between birth centre and hospital

Structure

Relevance

6

84

Include

 

Feasible

7

96

 

 Joint use of an electronic patient record

Structure

Relevance round 1

6

87,6

Submit again

 

Feasible round 1

6

66,7

Relevance round 2

6

95,2

 

Include

Feasible round 2

6

85,7

 System of quality improvement (i.e. accreditation)

Structure

Relevance round 1

6

70,9

Submit again

 

Feasible round 1

5

56,3

Relevance round 2

6

85,7

 

Decision Research group: include

Feasible round 2

5

80,9

 Multidisciplinary education as result of formulated points of improvement from perinatal audit

Process

Relevance round 2

6

90,5

New in round 2

Include

Feasible round 2

6

83,3

Domain: equity

 Care pathways formulated with chain partners

Structure

Relevance

6

95,9

Include

 

Feasible

6

79,2

 

 Birth centre has vision of birth care

Structure

Relevance

7

91,8

Include

 

Feasible

6

75

 

 Formal partnership agreement with chain partners

Structure

Relevance

6

83,4

Include

 

Feasible

7

81,3

 

 Admission agreement for professionals who use birth care facilities at the birth centre

Structure

Relevance round 1

6

69,3

Submit again

 

Feasible round 1

7

75,5

Relevance round 2

6

81

 

Include

Feasible round 2

7

85,7

Domain: accessibility

 24 /7 telephone accessibility birth centre

Process

Relevance

7

100

Include

 

Feasible

7

98

 

 Physical access to birthing centre for clients (i.e. parking)

Structure

Relevance

7

96

Include

 

Feasible

6

78

 

 Physical access to birthing centre for midwives and maternity care assistants (e.g. parking)

Structure

Relevance

6

92

Include

 

Feasible

6

80

 

Domain: patient-centeredness

 Facilities at a birth centre in relation to pain management (i.e. nitrous oxide)

Structure

Relevance

6

100

Include

 

Feasible

6

83,7

 

 Continuous presence of a healthcare provider during laboura

Process

Relevance

7

98

Include

 

Feasible

6

81,3

 

 Structural research on client experiences

Structure

Relevance

7

98

Include

 

Feasible

6

85,5

 

 Focusing on the patients (i.e. use individual birth plan)

Process

Relevance

6

89,6

Include

 

Feasible

6

83,4

 

 Participation and representation of clients in organisation (i.e. in the board)

Structure

Relevance round 2

6

85,7

New in round 2

Include

Feasible round 2

6

78,6

  1. aThese determinants appear similar but are different: ‘Continuous presence of a healthcare provider during labour’ refers to continuous support of labour (not leaving alone the woman in labour). ‘Maternity care assistant present during labour’ refers to the presence of assistance of the midwife during childbirth. In the Netherlands, the midwife attends birth of low risk women, regardless the location (at home, in a birth centre or in a hospital) and is assisted by a maternity care assistant. Sometimes, it happens that the maternity care assistant is too late present at the childbirth to assist the midwife adequately. This determinant refers to this aspect
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BMC Pregnancy and Childbirth

ISSN: 1471-2393

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