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The measurement and improvement of maternity service performance through inspection and rating: An observational study of maternity services in acute hospitals in England.

ABSTRACT: OBJECTIVES:To determine whether the prior performance of maternity services, as measured by Royal College of Obstetricians and Gynaecologists performance indicators, is associated with ratings by the Care Quality Commission at subsequent inspection, and whether performance changes occur after inspection. METHODS:We used hospital activity data from 176 maternity sites inspected between October 2013 and March 2016 to generate a set of performance indicators developed by the Royal College of Obstetricians and Gynaecologists. We linked these data to Care Quality Commission data on inspection dates and rating scores and used regression models, controlling for site level effects, to estimate the relationships between inspection ratings and performance indicators before and after inspections. RESULTS:Coefficients measuring the relationship between indicator performance and subsequent inspection rating score had wide confidence intervals which crossed zero suggesting no statistically significant relationship prior to inspection. The same absence of statistical significance was observed for changes in indicator performance after inspection. CONCLUSIONS:The use of routine data for performance monitoring is becoming increasingly important as regular inspection is costly and regulators require accurate and timely intelligence. However, we found no statistically significant relationships between inspection ratings and performance indicators before or after inspections in maternity services. This calls into question the validity and reliability of the performance indicators, the inspection process and ratings, or both, as measures of performance.

SUBMITTER: Allen T

PROVIDER: S-EPMC7584108 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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The measurement and improvement of maternity service performance through inspection and rating: An observational study of maternity services in acute hospitals in England.

Allen Thomas T Walshe Kieran K Proudlove Nathan N Sutton Matt M

Health policy (Amsterdam, Netherlands) 20200826 11

<h4>Objectives</h4>To determine whether the prior performance of maternity services, as measured by Royal College of Obstetricians and Gynaecologists performance indicators, is associated with ratings by the Care Quality Commission at subsequent inspection, and whether performance changes occur after inspection.<h4>Methods</h4>We used hospital activity data from 176 maternity sites inspected between October 2013 and March 2016 to generate a set of performance indicators developed by the Royal Co ...[more]

PMID: 32919795

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Project description:ObjectivesHealth system reforms in England are opening broad areas of clinical practice to new providers of care. As part of these reforms, new entrants--including private companies--have been allowed into the primary care market under 'alternative provider of medical services' contracting mechanisms since 2004. The characteristics and performance of general practices working under new alternative provider contracts are not well described. We sought to compare the quality of care provided by new entrant providers to that provided by the traditional model of general practice.DesignOpen cohort study of English general practices. We used linear regression in cross-sectional and time series analyses, adjusting for practice and population characteristics, to compare quality in practices using alternative provider contracts to traditional practices. We created regression models using practice fixed effects to estimate the impact of practices changing to the new contract type.SettingThe English National Health Service.ParticipantsAll general practices open from 2008/2009 to 2012/2013.Main outcome measuresSeventeen established quality indicators--covering clinical effectiveness, efficiency, access and patient experience.ResultsIn total, 4.1% (347 of 8300) of general practices in England were run by alternative contract providers. These practices tended to be smaller, and serve younger, more diverse and more deprived populations than traditional providers. Practices run by alternative providers performed worse than traditional providers on 15 of 17 indicators after adjusting for practice and population characteristics (p?<?0.01 for all). Switching to a new alternative provider contract did not result in improved performance.ConclusionsThe introduction of new alternative providers to deliver primary care services in England has not led to improvements in quality and may have resulted in worse care. Regulators should ensure that new entrants to clinical provider markets are performing to adequate standards and at least as well as traditional providers.

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Dataset Information

The measurement and improvement of maternity service performance through inspection and rating: An observational study of maternity services in acute hospitals in England.

Publications

The measurement and improvement of maternity service performance through inspection and rating: An observational study of maternity services in acute hospitals in England.

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