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Indicators for the Dutch maternity home care. Development of indicators

Indicatoren voor de kraamzorg. Ontwikkeling van indicatoren voor kraamzorginstellingen


The Dutch Inspectorate for Healthcare (IGZ) is working on the development of a strategy to manage the risks of sub-optimal care. This strategy is based on the measurement of performance indicators. Poor results on these indicators by a health care service, will result in an in-depth inspection by the inspectorate. For this purpose we developed in this study a set of indicators for maternity home care in the Netherlands, based on scientific literature and consensus among experts. We used four steps in the development of the set indicators. The first step was a search in the literature to find risks involved in maternity home care. In the second step, a panel of experts in the field of maternity home care discussed the risks found in the literature and added new risks based on their expert opinion. We identified 116 descriptions of risks as a result of the first two steps. In the third step, a limited number of experts made a first selection of the most relevant risks and defined indicators to measure these risks. Finally, in the fourth step, experts made an assessment of the indicators in a Delphi procedure. This resulted in a final set of 20 indicators. The set contains indicators for processes and the structures in the maternity care delivery. For example: the use of a breast feeding expert, the percentage of intakes done at the home of the client, the use of a protocol to signal under nutrition, and the availability of a protocol describing the cooperation with the midwives and general practitioner. In this study we focused on a feasible set of indicators based on routinely collected data. No outcome-indicator passed the test for this availability criterion. In the field of maternity home care in the Netherlands, the data collection and processing is insufficient to include outcome-indicators at this moment. This set of indicators is a good first step in the development of transparency of the quality of maternity home care in the Netherlands.

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