Can Patient Reported Outcome Measures be used in Maternity services? – A systematic review

News article 23 May 2019

Researchers at the Centre for Maternal and Newborn Health (CMNH) have conducted a systematic review to identify any Patient Reported Outcome Measures (PROMs) which are used in maternity services. They then assessed each one for how suitable it might be for assessing the quality of care provided to women in low- and middle-income countries. The study, Patient reported outcome measures for use in pregnancy and childbirth: a systematic reviewwas published in BMC Pregnancy and Childbirth.

As increasing numbers of women globally are giving birth in healthcare facilities, it is crucial to have ways to assess the quality of care that they receive. PROMs provide a means of collecting data from patients themselves on their health outcomes: for example, amongst other things, a PROM might ask women to what extent they have experienced pain in the last 2 weeks. When combined, these can then be used as a measure of the quality of care the women have received.

The systematic review identified six academic papers which had been written from studies that used PROMs. The studies ranged from assessing the impact of hyperemesis gravidarum (severe vomiting during pregnancy) and gestational diabetes during pregnancy to postpartum haemorrhage and postnatal depression following birth, and used a total of 14 different PROMS. From these papers, only one PROM was found which addressed childbirth generally. However, this particular PROM did not specify individual outcomes to be assessed but instead left the choice to the women completing the questionnaire. This meant that they could list outcomes unrelated to the care they received in hospital, therefore making it less useful for this type of research.

Overall, the researchers did not find any PROM that broadly addressed health outcomes of women during pregnancy and childbirth, which they felt would be useful in assessing the quality of care provided to women in healthcare facilities in LMICs. The existing PROMs only addressed individual aspects of pregnancy or the postnatal period (eg gestational diabetes). This being so, the review has enabled them to identify a number of assessment tools which could potentially be helpful in developing new PROMs for maternity care. The CMNH team are now in the process of developing such a PROM, suitable to meet this need and hope to ultimately contribute to the improvement of care provided for women during and after childbirth.

Fiona Dickinson, Research Assistant at CMNH and lead author on this paper:
“Although this piece of research didn’t identify any singularly useful PROM, this review is important in that it clearly demonstrates a gap in available assessment tools in this important area of research. We are now in the final stages of developing a proposed PROM, based on input from women in LMICs and for use in promoting the highest possible quality of care for women and babies in these countries.”