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Classification of substandard factors in perinatal care: development and multidisciplinary inter-rater agreement of the Groningen-system
BACKGROUND: Perinatal audit is an established method for improving the quality of perinatal care. In audit meetings substandard factors (SSF) are identified in cases of perinatal mortality and morbidity. To our knowledge there is no classification system specifically designed for the classification...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4567791/ https://www.ncbi.nlm.nih.gov/pubmed/26361757 http://dx.doi.org/10.1186/s12884-015-0638-5 |
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author | van Diem, Mariet Th. Timmer, Albertus Gordijn, Sanne J. Bergman, Klasien A. Korteweg, Fleurisca J. Ravise, Joke Vreugdenhil, Ellen Erwich, Jan Jaap H.M. |
author_facet | van Diem, Mariet Th. Timmer, Albertus Gordijn, Sanne J. Bergman, Klasien A. Korteweg, Fleurisca J. Ravise, Joke Vreugdenhil, Ellen Erwich, Jan Jaap H.M. |
author_sort | van Diem, Mariet Th. |
collection | PubMed |
description | BACKGROUND: Perinatal audit is an established method for improving the quality of perinatal care. In audit meetings substandard factors (SSF) are identified in cases of perinatal mortality and morbidity. To our knowledge there is no classification system specifically designed for the classification of substandard factors. Such a classification may help to standardise allocation of substandard factors to categories. This will help to prioritise, guide and implement actions in quality improvement programs. METHODS: A classification system of 284 substandard factors (SSF) identified in perinatal audit meetings between 2007 and 2011 was drawn up using the WHO Conceptual Framework for the International Classification for Patient Safety as a starting point. Discussions were held on inter-rater disagreements, inclusion of items, format and organisation and definitions of the main- and subcategories. A guideline was developed. An independent multidisciplinary group tested the classification. Independent of inter-rater agreement the allocations to categories were counted. For the counts in the subcategories one and two, we used the allocations in the main category as reference. The chance corrected agreement between classifiers was tested with Cohen's kappa statistic. RESULTS: The classification consists of 9 main categories with one or two subcategories. The main categories are (1) Equipment and Materials, (2) Medication, (3) Additional tests/ investigations, (4) Transportation , (5) Documentation, (6) Communication, (7) Medical practice, (8) Other and (9) non classifiable. Of 3663 allocations by 13 classifiers 1452 SSF’s were allocated (40 %) to ‘medical practice’ and 1247 (34 %) to ‘documentation’. 118 (3 %) times SSF’s were not classifiable, mainly due to unclear phrasing of the SSF. The chance corrected agreement of 284 substandard factors in the main category was 0.68 (95 % CI 0.66-0.70) and 0.57 (95 % CI 0.54-0.59) for the CDG and the IGD respectively. CONCLUSIONS: Classifying substandard factors has given insight into problem area's in perinatal care and can give direction to medical, political and financial quality improvement measures. The Groningen-system has well defined categories and subcategories and the guidelines and examples are clear. The multidisciplinary inter-rater agreement is moderate to good. Improvement of the phrasing of the substandard factors is expected to improve inter-rater agreement. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12884-015-0638-5) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-4567791 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-45677912015-09-13 Classification of substandard factors in perinatal care: development and multidisciplinary inter-rater agreement of the Groningen-system van Diem, Mariet Th. Timmer, Albertus Gordijn, Sanne J. Bergman, Klasien A. Korteweg, Fleurisca J. Ravise, Joke Vreugdenhil, Ellen Erwich, Jan Jaap H.M. BMC Pregnancy Childbirth Research Article BACKGROUND: Perinatal audit is an established method for improving the quality of perinatal care. In audit meetings substandard factors (SSF) are identified in cases of perinatal mortality and morbidity. To our knowledge there is no classification system specifically designed for the classification of substandard factors. Such a classification may help to standardise allocation of substandard factors to categories. This will help to prioritise, guide and implement actions in quality improvement programs. METHODS: A classification system of 284 substandard factors (SSF) identified in perinatal audit meetings between 2007 and 2011 was drawn up using the WHO Conceptual Framework for the International Classification for Patient Safety as a starting point. Discussions were held on inter-rater disagreements, inclusion of items, format and organisation and definitions of the main- and subcategories. A guideline was developed. An independent multidisciplinary group tested the classification. Independent of inter-rater agreement the allocations to categories were counted. For the counts in the subcategories one and two, we used the allocations in the main category as reference. The chance corrected agreement between classifiers was tested with Cohen's kappa statistic. RESULTS: The classification consists of 9 main categories with one or two subcategories. The main categories are (1) Equipment and Materials, (2) Medication, (3) Additional tests/ investigations, (4) Transportation , (5) Documentation, (6) Communication, (7) Medical practice, (8) Other and (9) non classifiable. Of 3663 allocations by 13 classifiers 1452 SSF’s were allocated (40 %) to ‘medical practice’ and 1247 (34 %) to ‘documentation’. 118 (3 %) times SSF’s were not classifiable, mainly due to unclear phrasing of the SSF. The chance corrected agreement of 284 substandard factors in the main category was 0.68 (95 % CI 0.66-0.70) and 0.57 (95 % CI 0.54-0.59) for the CDG and the IGD respectively. CONCLUSIONS: Classifying substandard factors has given insight into problem area's in perinatal care and can give direction to medical, political and financial quality improvement measures. The Groningen-system has well defined categories and subcategories and the guidelines and examples are clear. The multidisciplinary inter-rater agreement is moderate to good. Improvement of the phrasing of the substandard factors is expected to improve inter-rater agreement. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12884-015-0638-5) contains supplementary material, which is available to authorized users. BioMed Central 2015-09-11 /pmc/articles/PMC4567791/ /pubmed/26361757 http://dx.doi.org/10.1186/s12884-015-0638-5 Text en © van Diem et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article van Diem, Mariet Th. Timmer, Albertus Gordijn, Sanne J. Bergman, Klasien A. Korteweg, Fleurisca J. Ravise, Joke Vreugdenhil, Ellen Erwich, Jan Jaap H.M. Classification of substandard factors in perinatal care: development and multidisciplinary inter-rater agreement of the Groningen-system |
title | Classification of substandard factors in perinatal care: development and multidisciplinary inter-rater agreement of the Groningen-system |
title_full | Classification of substandard factors in perinatal care: development and multidisciplinary inter-rater agreement of the Groningen-system |
title_fullStr | Classification of substandard factors in perinatal care: development and multidisciplinary inter-rater agreement of the Groningen-system |
title_full_unstemmed | Classification of substandard factors in perinatal care: development and multidisciplinary inter-rater agreement of the Groningen-system |
title_short | Classification of substandard factors in perinatal care: development and multidisciplinary inter-rater agreement of the Groningen-system |
title_sort | classification of substandard factors in perinatal care: development and multidisciplinary inter-rater agreement of the groningen-system |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4567791/ https://www.ncbi.nlm.nih.gov/pubmed/26361757 http://dx.doi.org/10.1186/s12884-015-0638-5 |
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