Value Based Perinatal Care: Women at the centre of learning healthcare networks

Our healthcare system is under increasing pressure, both in terms of financial and human capacity, which forces us into difficult choices. Value-based healthcare offers a theory in which the outcomes of care that matter to patients, relative to the costs incurred, are leading in these choices. Important principles of value-based healthcare are organizing care around the patient and gaining insight into care outcomes that matter to patients. In perinatal care, collaboration around the pregnant woman (integrated maternity care) is already underway, but relatively little insight exists into care results from the patient's perspective. In this thesis, we investigated how structured questionnaires on patient-reported outcomes of perinatal care, such as breastfeeding or incontinence, and experiences, such as satisfaction or autonomy, can contribute to improved care. In clinic, we saw that discussing answers individually as part of regular care contacts helped to identify complaints and personalize care, provided that the questionnaires were properly aligned with the care path. At group level, the insight into outcome data gave healthcare providers motivation for quality improvement. Translating the data into recognizable personas helped to achieve substantive discussion and improvement actions. The network-wide approach to measuring and improving outcomes ensured patient-centeredness but hindered implementation. The iterative, context-specific approach of action research helped to achieve change. The findings in this thesis provide direction for the implementation and application of patient-reported measures around pregnancy and childbirth to strengthen the development towards a healthcare system driven by value for patients.