Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2019

Open Access 01-12-2019 | Research article

Effect of implementation of the MOREOB program on adverse maternal and neonatal birth outcomes in Ontario, Canada: a retrospective cohort study

Authors: Deborah Weiss, Deshayne B. Fell, Ann E. Sprague, Mark C. Walker, Sandra Dunn, Jessica Reszel, Wendy E. Peterson, Doug Coyle, Monica Taljaard

Published in: BMC Pregnancy and Childbirth | Issue 1/2019

Login to get access

Abstract

Background

In 2002, the MOREOB (Managing Obstetrical Risk Efficiently) obstetrical patient safety program was phased-in across hospitals in Ontario, Canada. The purpose of our study was to evaluate the effect of the MOREOB program on rates of adverse maternal and neonatal outcomes.

Methods

A retrospective cohort study, using province-wide administrative hospitalization data. We included maternal and neonatal records between fiscal years 2002–2003 and 2013–2014, for deliveries taking place at the 67 Ontario hospitals where the MOREOB program was implemented between 2002 and 2012. After accounting for institutional mergers and excluding very small hospitals, 55 hospitals (1,447,073 deliveries) were included.
Multivariable logistic and linear mixed effects regression analysis were used, accounting for secular trends, within hospital correlation and over time correlation, and adjusting for a maternal comorbidity index, hospital annual birth volume, and level of care.
The main outcome measure was a composite individual-level indicator of incidence of any adverse events, and a hospital-level score, called the Weighted Adverse Outcome Score (WAOS) capturing both maternal and neonatal adverse outcomes.

Results

Across the 12 years of follow up, there were 98,789 adverse maternal and neonatal outcomes, a rate of 6.83 per 100 deliveries (6.66 per 100 occurring before, 6.91 per 100 during, and 6.84 per 100 after program implementation). The multivariable analysis found no statistically significant decrease in adverse events associated with program implementation (OR for adverse events after versus before =1.11 (95% CI: 1.06 to 1.17, change in mean WAOS score after minus before =0.15 (− 0.36 to 0.67)).

Conclusions

We did not find a reduction in the incidence of maternal and neonatal adverse outcomes associated with the MOREOB program, and small yet statistically significant increases in some adverse events were observed.
Appendix
Available only for authorised users
Literature
1.
Public Health Agency of Canada. Canadian perinatal health report. Ottawa, Canada; 2008.
2.
Public Health Agency of Canada. Perinatal Health Indicators for Canada 2017. Ottawa, Canada; 2017.
3.
4.
Pettker CM, Thung SF, Lipkind HS, Illuzzi JL, Buhimschi CS, Raab CA, et al. A comprehensive obstetric patient safety program reduces liability claims and payments. Am J Obstet Gynecol. 2014;211:319–25.CrossRefPubMed
5.
Pettker CM, Thung SF, Norwitz ER, Buhimschi CS, Raab CA, Copel JA, et al. Impact of a comprehensive patient safety strategy on obstetric adverse events. Am J Obstet Gynecol. 2009;200:1–8.CrossRef
6.
Nielsen PE, Goldman MB, Mann S, Shapiro DE, Marcus RG, Pratt SD, et al. Effects of teamwork training on adverse outcomes and process of care in labor and delivery: a randomized controlled trial. Obstet Gynecol. 2007;109:48–55.CrossRefPubMed
7.
8.
Milne JK, Walker DE, Vlahaki D. Reflections on the Canadian MOREOB obstetrical risk management programme. Best Pract Res Clin Obstet Gynaecol. 2013;27:563–9.CrossRefPubMed
9.
10.
Geary M, Ruiter PJA, Yasseen AS. Examining the effects of an obstetrics interprofessional programme on reductions to reportable events and their related costs. J Interprof Care. 2018:1–9 [Epub ahead of print].
11.
Thanh NX, Jacobs P, Wanke MI, Hense A, Sauve R. Outcomes of the introduction of the MOREOB continuing education program in Alberta. J Obstet Gynaecol Can. 2010;32:749–55.CrossRefPubMed
12.
Grimshaw J, Campbell M, Eccles M, Steen N. Experimental and quasi-experimental designs for evaluating guideline implementation strategies. Fam Pract. 2000;17:s11–6.CrossRefPubMed
13.
Craig P, Cooper C, Gunnell D, Haw S, Lawson K, Macintyre S, et al. Using natural experiments to evaluate population health interventions: new Medical Research Council guidance. J Epidemiol Community Health. 2012;66:1182–6.CrossRefPubMedPubMedCentral
14.
Carroll N. Application of segmented regression analysis to the Kaiser Permanente Colorado critical drug interaction program. Proceedings of the Western Users of SAS Software 2008 Conference; Universal City, California, USA; November 5–7, 2008.
15.
Handley MA, Schillinger D, Shiboski S. Quasi-experimental designs in practice-based research settings: design and implementation considerations. J Am Board Fam Med. 2011;24:589–96.CrossRefPubMed
16.
17.
Canadian Institute for Health Information. Data quality documentation, discharge abstract database — multi-year information standards and data submission. 2012.
18.
Mann S, Pratt S, Gluck P, Nielsen P, Risser D, Greenberg P, et al. Assessing quality in obstetrical care: development of standardized measures. Jt Comm J Qual Patient Saf. 2006;32:497–505.CrossRefPubMed
19.
Hutcheon JA, Lee L, Joseph KS, Kinniburgh B, Cundiff GW. Feasibility of implementing a standardized clinical performance indicator to evaluate the quality of obstetrical Care in British Columbia. Matern Child Health J. 2015;19:2688–97.CrossRefPubMed
20.
Zhang J-W, Branch W, Hoffman M, De Jonge A, Li S-H, Troendle J, et al. In which groups of pregnant women can the caesarean delivery rate likely be reduced safely in the USA? A multicentre cross-sectional study. BMJ Open. 2018;8(8):e021670.CrossRefPubMedPubMedCentral
21.
Liu S, Joseph KS, Bartholomew S, Fahey J, Lee L, Allen AC, et al. Temporal trends and regional variations in severe maternal morbidity in Canada, 2003 to 2007. J Obs Gynaecol Can. 2010;32:847–55.CrossRef
22.
Mehrabadi A, Liu S, Bartholomew S, Hutcheon JA, Kramer MS, Liston RM, et al. Temporal trends in postpartum hemorrhage and severe postpartum hemorrhage in Canada from 2003 to 2010. J Obstet Gynaecol Canada. 2014;36:21–33.CrossRef
23.
Aubrey-Bassler K, Cullen RM, Simms A, Asghari S, Crane J, Wang PP, et al. Outcomes of deliveries by family physicians or obstetricians: a population-based cohort study using an instrumental variable. CMAJ. 2015;187(15):1125–32.CrossRefPubMedPubMedCentral
24.
Chen Y-F, Hemming K, Stevens AJ, Lilford RJ. Secular trends and evaluation of complex interventions: the rising tide phenomenon. BMJ Qual Saf. 2016;25:303–10.CrossRefPubMed
25.
Bateman BT, Mhyre JM, Hernandez-Diaz S, Huybrechts KF, Fischer MA, Creanga AA, et al. Development of a comorbidity index for use in obstetric patients. Obstet Gynecol. 2013;122(5):957–65.CrossRefPubMed
26.
Metcalfe A, Lix LM, Johnson JA, Currie G, Lyon AW, Bernier F, et al. Validation of an obstetric comorbidity index in an external population. BJOG. 2015;122:1748–55.CrossRefPubMedPubMedCentral
27.
Canadian Institute for Health Information. CIHI’s information quality framework. Ottawa; 2017.
28.
Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011;104:510–20.CrossRefPubMedPubMedCentral
29.
Hanney SR, Castle-Clarke S, Grant J, Guthrie S, Henshall C, Mestre-Ferrandiz J, et al. How long does biomedical research take ? Studying the time taken between biomedical and health research and its translation into products , policy, and practice. Heal Res Policy Syst. 2015;13:1–18.CrossRef
Metadata
Title
Effect of implementation of the MOREOB program on adverse maternal and neonatal birth outcomes in Ontario, Canada: a retrospective cohort study
Authors
Deborah Weiss
Deshayne B. Fell
Ann E. Sprague
Mark C. Walker
Sandra Dunn
Jessica Reszel
Wendy E. Peterson
Doug Coyle
Monica Taljaard
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2019
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-019-2296-5

Other articles of this Issue 1/2019

BMC Pregnancy and Childbirth 1/2019 Go to the issue

Research article

Unexpected drug residuals in human milk in Ankara, capital of Turkey

Research article

mHealth communication to strengthen postnatal care in rural areas: a systematic review

Research article

Caregiving can be costly: A qualitative study of barriers and facilitators to conducting kangaroo mother care in a US tertiary hospital neonatal intensive care unit

Research article

Factors associated with recruitment, surveillance participation, and retention in an observational study of pregnant women and influenza

Research article

Deceleration of fetal growth rate as alternative predictor for childhood outcomes: a birth cohort study

Research article

Poverty, urban-rural classification and term infant mortality: a population-based multilevel analysis