Objectives To assess the effect of the Maternal Newborn Dashboard on six key clinical performance indicators in the province of Ontario, Canada.
Design Interrupted time series using population-based data from the provincial birth registry covering a 3-year period before implementation of the Dashboard and 2.5 years after implementation (November 2009 through March 2015).
Setting All hospitals in the province of Ontario providing maternal-newborn care (n=94).
Intervention A hospital-based online audit and feedback programme.
Main outcome measures Rates of the six performance indicators included in the Dashboard.
Results 2.5 years after implementation, the audit and feedback programme was associated with statistically significant absolute decreases in the rates of episiotomy (decrease of 1.5 per 100 women, 95% CI 0.64 to 2.39), induction for postdates in women who were less than 41 weeks at delivery (decrease of 11.7 per 100 women, 95% CI 7.4 to 16.0), repeat caesarean delivery in low-risk women performed before 39 weeks (decrease of 10.4 per 100 women, 95% CI 9.3 to 11.5) and an absolute increase in the rate of appropriately timed group B streptococcus screening (increase of 2.8 per 100, 95% CI 2.2 to 3.5). The audit and feedback programme did not significantly affect the rates of unsatisfactory newborn screening blood samples or formula supplementation at discharge. No statistically significant effects were observed for the two internal control outcomes or the four external control indicators—in fact, two external control indicators (episiotomy and postdates induction) worsened relative to before implementation.
Conclusion An electronic audit and feedback programme implemented in maternal-newborn hospitals was associated with clinically relevant practice improvements at the provincial level in the majority of targeted indicators.
- audit and feedback
- health services research
- implementation science
- obstetrics and gynecology
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Handling editor Kaveh G Shojania
Contributors SID, AES, DBF, JMG, ED, IDG, JH, GNS, WEP, MCW and MT contributed to the conception, design and implementation of the study, and acquired funding. DW carried out the analyses, interpreted the analyses, and drafted and revised the manuscript. All authors contributed to the acquisition, analysis and interpretation of the data. All authors participated in the writing of this manuscript and reviewed and approved the final manuscript, and take responsibility for the integrity of the data and the accuracy of the data analysis. SID as co-PI is guarantor.
Funding This study was funded by the Canadian Institutes of Health Research (CIHR- FRN: 133576) and the Ontario Ministry of Health and Long-Term Care (MOHLTC - 06684).
Competing interests All authors have completed the ICMJE uniform disclosure form and declare the following: SID, AES, DBF, JMG, ED, IDG, JH, WEP, MCW and MT report grants from CIHR-Operating Grant and grants from MOHLTC-HSRF Capacity Award, during the conduct of the study. The authors declare no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years, and no other relationships or activities that could appear to have influenced the submitted work.
Ethics approval Children’s Hospital of Eastern Ontario Research Ethics Board (#13/218X) and University of Ottawa Research Ethics Board (#A01-14-03).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The data set for this study is held securely at the Ontario prescribed registry Better Outcomes Registry & Network (BORN). Data sharing regulations prevent this data from being made available publicly. Enquiries regarding BORN data may be directed to Science@BORNOntario.ca.
Correction notice This article has been updated to correct typographical errors in the main text.
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