Denne side blev automatisk oversat, og nøjagtigheden af ​​oversættelsen er ikke garanteret. Der henvises til engelsk version for en kildetekst.

Current Dutch Practice on Caesarean Sections: Identification of Barriers and Facilitators for Optimal Care (SIMPLE)

29. oktober 2012 opdateret af: Maastricht University Medical Center

Current Dutch Practice on Caesarean Sections: Identification of Barriers and Facilitators for Optimal Care.

Caesarean (CS) delivery rates in the Netherlands increased from 5 to 15% the last 20 years. CSs have no clear benefit for overall neonatal outcome and are associated with higher maternal complications and high costs. Dutch guidelines offer clear recommendations on factors that have a direct effect on the decision to perform a CS.

Hypothesis: there is incomplete adherence to the recommendations from the guidelines on CS among Dutch gynaecologists.

This study consists of four phases:

  1. Development of quality indicators: A set of quality indicators regarding the process, structure and outcome of care will be developed according to the RAND-modified Delphi method. A representative, national expert panel consisting of 12 to 15 obstetricians and midwives will participate.
  2. Current care study: The current Dutch care will be studied in 20 hospitals (N=80 gynaecologists). 1000 files on performed CSs are analyzed regarding the adherence to the developed quality indicators. To get insight into Dutch practices compared to international data, basic obstetrical data will be extracted from the delivery database.
  3. Barrier analysis: A barrier analysis will be carried out based on the results of the current care study. Two groups of hospitals will be identified in the upper and lower extremes of the 'adherence distribution': 5 hospitals with the lowest and 5 hospitals with the highest adherence scores. Factors that determine the decision to perform a CS or not (barriers and facilitators) will be analyzed in both groups using semi-structured interviews among 15-20 professionals and 15-20 patients. A questionnaire will be used to study the 'prevalence' of these factors among all obstetric gynaecologists in the Netherlands and among 200 patients.
  4. Controlled before- and-after (CBA) study: Based on the outcomes of the current care study and the barrier analysis, a tailor made implementation strategy will be developed in order to increase adherence to the CS quality indicators. Target groups will be selected with focus on women with both a high incidence of the indicator and low indicator adherence. The strategy will be executed and evaluated in a CBA-study in 12 hospitals (6 intervention, 6 control) in terms of effectiveness, experiences and costs. The sample size will be dependent on the target group and adherence to the quality indicators regarding this target group. These data will be available after performing the current care and the barrier study.

Studieoversigt

Status

Ukendt

Betingelser

Intervention / Behandling

Undersøgelsestype

Observationel

Tilmelding (Forventet)

1000

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Holland
      • Almelo, Holland
        • Ziekenhuisgroep Twente
      • Almere, Holland
        • Flevo ziekenhuis
      • Amersfoort, Holland
        • Meander Medisch Centrum
      • Amsterdam, Holland
        • Academisch Medisch Centrum
      • Apeldoorn, Holland
        • Gelreziekenhuizen
      • Arnhem, Holland
        • Rijnstate Ziekenhuis
      • Capelle aan den Ijjsel, Holland
        • IJsselland Ziekenhuis
      • Eindhoven, Holland
        • Catharina-Ziekenhuis
      • Groningen, Holland
        • University Medical Centre Groningen
      • Hardenberg, Holland
        • Ropcke-Zweers Ziekenhuis
      • Heerlen, Holland
        • Atrium Medisch Centrum Parkstad
      • Helmond, Holland
        • Elkerliek Ziekenhuis
      • Hilversum, Holland
        • Tergooiziekenhuizen
      • Maastricht, Holland
        • Maastricht Universitair Medisch Centrum
      • Nijmegen, Holland
        • Universitair Medisch Centrum St. Radboud
      • Sittard, Holland
        • Orbis Medisch Centrum
      • Utrecht, Holland
        • Universitair Medisch Centrum Utrecht
      • Veldhoven, Holland
        • Maxima Medisch Centrum
      • Weert, Holland
        • Sint Jansgasthuis
      • Zaandam, Holland
        • Zaans Medisch Centrum

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

  • Barn
  • Voksen
  • Ældre voksen

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Kvinde

Prøveudtagningsmetode

Ikke-sandsynlighedsprøve

Studiebefolkning

  1. Development of quality indicators: 12-15 obstetricians and midwives
  2. Current care study: All women (1000) who underwent a CS in one of the 20 participating hospitals during the study period (3-4 months). All hospitals participate in the Dutch consortium and consist of university teaching-, non-university teaching- and non-university-non-teaching hospitals.
  3. Barrier analysis: Qualitative: 15-20 professionals and 15-20 patients from the hospitals in the upper and lower extremes of the 'adherence distribution'. Quantitative: obstetricians in the Netherlands and 200 experienced patients.
  4. CBA study: depending on the outcome of phase 2 and 3 of the study, the implementation strategy will be designed for a target group with low guideline adherence and high incidence.

Beskrivelse

Inclusion Criteria:

  • A previous caesarean section in a 3-4 month time period.

Exclusion Criteria:

  • Major congenital malformality
  • Fetal death prior to onset of delivery
  • Duration of pregnancy less than 24 weeks of gestation

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

Kohorter og interventioner

Gruppe / kohorte
Intervention / Behandling
Caesarean section
Andet: Implementation aids
An implementation strategy to improve outcome for women in labour will be developed depending on the outcome of the current care study and the barrier and facilitator analysis.The strategy will be executed and evaluated in a controlled before-and-after study in 12 hospitals (6 intervention, 6 control)
Vaginal birth (control)
Andet: Implementation aids
An implementation strategy to improve outcome for women in labour will be developed depending on the outcome of the current care study and the barrier and facilitator analysis.The strategy will be executed and evaluated in a controlled before-and-after study in 12 hospitals (6 intervention, 6 control)

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Tidsramme
1) Development of quality indicators: development of a valid set of quality indicators for measuring current Dutch care on caesarean sections
Tidsramme: December 2010 - October 2013
December 2010 - October 2013
2) Current care study: The main outcome is the adherence to the quality indicators regarding the process, structure and outcome (maternal and fetal) of care
Tidsramme: December 2010 - October 2013
December 2010 - October 2013
3) Barrier and facilitator analysis: Identification of barriers and facilitators to perform a caesarean section
Tidsramme: December 2010 - October 2013
December 2010 - October 2013
4) Controlled before-and-after study: effectiveness of the implementation strategy defined as observed increase in adherence between the intervention and control hospitals and actual CS rates in both groups
Tidsramme: December 2010 - October 2013
December 2010 - October 2013

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
1) Development of quality indicators: no secondary outcomes
Tidsramme: December 2010 - October 2013
December 2010 - October 2013
2) Current care study: International comparison
Tidsramme: December 2010- October 2013
Dutch practice as compared to international data (Robson criteria)
December 2010- October 2013
3) Barrier and facilitator analysis: no secondary outcomes
Tidsramme: December 2010-October 2013
December 2010-October 2013
4) Controlled before-and-after study: experiences and satisfaction of health care providers and patients with the implementation strategy and applicability and costs of the strategy
Tidsramme: December 2010-October 2013
December 2010-October 2013

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Maastricht University Medical Center

Samarbejdspartnere

ZonMw: The Netherlands Organisation for Health Research and Development

Efterforskere

  • Ledende efterforsker: Hubertina CJ Scheepers, Ph.D., Maastricht University Medical Center

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart

1. december 2010

Primær færdiggørelse (Forventet)

1. oktober 2013

Datoer for studieregistrering

Først indsendt

15. december 2010

Først indsendt, der opfyldte QC-kriterier

15. december 2010

Først opslået (Skøn)

16. december 2010

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Skøn)

30. oktober 2012

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

29. oktober 2012

Sidst verificeret

1. oktober 2012

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Andre undersøgelses-id-numre

  • 09-4-047
  • 17100.3006 (Andet bevillings-/finansieringsnummer: zonMW)

Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .

Kliniske forsøg med Implementation aids

Søg i lignende forsøg

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

CROs by country

CROs in Ireland

Betingelser

Sjældne sygdomme

Narkotikainterventioner

Kosttilskud

Sponsor / samarbejdspartnere

Placeringer

Abonner