❓How can we best use information gained from inspections alongside objective measures of care? How can stakeholders be involved when developing maternity rating systems? 9/9 #episky #obgynsky #midwife #obgyn #maternalcare #patientsafety #maternalhealth

obgyn.onlinelibrary.wiley.com/doi/10.1111/...

🔍 Clinical outcomes ought to be central to the evaluation of #maternity care. A range of national, systematically-collected and objective data that already exists could better inform the ratings process. We have to be able to identify under-performing hospitals early on. ⏳ 8/9

🧮 There was no difference after adjusting for case-mix or hospital characteristics. Although the risk of the outcomes and measures varied widely between individual hospitals, the ratings did not capture this variation. #maternitysafety 7/9

Severe maternal morbidity did not vary by rating: 1.2% (outstanding), 1.3% (good), 1.0% (RI OR inadequate), p=0.59. Nor did severe neonatal morbidity: 4.3%, 4.0%, 3.4% (p=0.48) or other outcomes (OASI, perinatal mortality, Apgar <7@5) or practice measures. 🚼 #maternitysafety 6/9

🚦 What did we find? During this period, 8% of births were in an 'outstanding' hospital and 21% in one either rated "requires improvement" (RI) or "inadequate". A higher proportion of women who gave birth in units rated RI/inadequate were from the most deprived areas (IMD), cf. "good". 5/9

🏥 The relationship between the CQC rating and obstetric practice measures was also considered: 'caesarean birth in labour' and 'non-spontaneous birth' (either induction or caesarean before labour) that tells us about the 'proactiveness' of care. 4/9

📊 We linked maternity and administrative data from over half a million births in the English #NHS, 2017-18, to study the relationship between the overall (and also "Safe" domain) rating and measures of severe maternal and #neonatal morbidity. 3/9

📋 #Maternity hospitals in England are inspected, have their quality evaluated in 5 domains, and receive an overall rating produced by the CQC (Outstanding to Inadequate). We might naturally assume the rating tells us something about the risk of harm to mothers or babies. #maternitysafety #epi 2/9

Love it. It's a shock realising we don't speak in Shakespearean verse. In a recent research interview I was delighted with my own clarity of thought with "yes yes yes no-no yeah yeah no".

Oh no the shareholders
www.unitetheunion.org/what-we-do/u...

As a healthcare professional with knowledge of the system, constantly chasing things that should but don't happen at every step is draining. If you aren't in a position to self-advocate you just don't receive high quality care. I can't imagine how much more difficult it is for people with barriers.

It's possible to misalign public and government priorities when they aren't asked who they want to see.

Strengthening provision of info/advice whenever someone seeks care for nausea and vomiting in pregnancy/advice on morning sickness could reach this particular group. VTE is an overlooked risk in mainstream communications on N&V - and the myth that there is no treatment even among HCWs persists.

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Did they actually study how many papers academics read?

I feel like Blake is an overlooked source of imagery to misappropriate for "final year of the PhD" memes.

Obviously quite a silly example.

The idea of multidisciplinary counselling seems to bring an important perspective here. The idea of shared decision making is uncomfortable though - patients have to know it is their decision alone. Counselling not shared decision making.

Potentially helpful for all academics to consider to what degree they should or could engage with/apply their methods to/pivot towards climate research/climate-related health/climate policy? So much ongoing research will become redundant as we cross planetary tipping points.