- Email: [email protected]
CAESAREAN DELIVERY ON MATERNAL REQUEST IN ONTARIO: TRENDS AND DETERMINANTS
Abstracts-SOGC ACSC 2019
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O-OBS-JM-067 ..........................................................................
CREATING COST CONSCIOUS RESIDENTS IN OBSTETRICS AND GYNECOLOGY: A RANDOMISED CONTROLLED TRIAL Allison Edwards, Fahrin Rawji, Maryna Yaskina, Sue Ross University of Alberta, Lois Hole Hospital for Women, Royal Alexandra Hospital, 10240 Kingsway Avenue NW, Edmonton, Alberta, Canada, T5H 3V9 Objectives: Residents have a professional obligation to the stewardship of healthcare resources yet there is a paucity of research on how to improve their cost-awareness. Rising health care expenditure has highlighted a critical need to improve education in this competency. This study aims to test if an educational module can teach residents to make cost-conscious management plans and reduce health care spending. Methods: All Canadian Obstetrics and Gynecology residents in 2017 were eligible for this randomised controlled trial. The study was administered online via REDCap. Interested residents were enrolled, stratified by level of training and block randomised. Residents completed a survey to determine their management of four obstetrical scenarios. The intervention group reviewed an educational module on cost-effective ordering prior to completing the survey; the control group had the option to review it after. The primary outcome was mean total expenditure as calculated from the survey. Student’s t-test was used to compare the mean total expenditure between the two groups. Results: 85 residents were enrolled, 63 residents completed study requirements (33 control and 30 intervention). Mean total expenditure was $291.03 CAD (95% confidence interval [CI] 259.38322.68) versus $192.98 CAD (95% CI 170.67-215.29) in the control and intervention groups respectively, corresponding to a 33.69% or $98.05 CAD (p=0.0001) reduction in total expenditure. Conclusions: This educational module decreased expenditure by Canadian Obstetrics and Gynecology residents in the management of hypothetical obstetrical cases. This introduces a potential curriculum innovation to improve resident education in judicious use of healthcare resources. Key Words: Health care costs, Resource allocation, Cost control
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O-OBS-MD-125 ........................................................................
CAESAREAN DELIVERY ON MATERNAL REQUEST IN ONTARIO: TRENDS AND DETERMINANTS Darine El-Chaar, Yanfang Guo, Daniel Corsi, Ruth White, Laura Gaudet, Mark Walker, Shi Wu Wen Ottawa Hospital Research Institute, 1967 Riverside Drive, 7th Floor, Ottawa, Ontario, Canada, K1H7W9 Objectives: Explore trends of Caesarean Delivery on Maternal Request (CDMR) in Ontario and the association between maternal socio-demographic, obstetric/neonatal, hospital factors and CDMR. We also reviewed differences in trends by differing terminology of CDMR. Methods: A population−based cohort study using BORN perinatal database (2012-2016, N= 668,468). After excluding labouring women, multiple gestations and women with indicated risks against labor, 5,576 CDMR cases remained. We used "maternal request" to indicate CDMR. Those not recorded as "maternal request" were categorized as "non-CDMR". Summary statistics were generated to describe population characteristics. Differences in socio-demographic, medical/obstetric/neonatal and hospital factors between CDMR and non-CDMR were compared. Continuous variables are
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MAY JOGC MAI 2019
described by mean§SD or median(IQR). Categorical variables are described by count and percentage. Comparisons between CDMR and non-CDMR are performed by t-test or Wilcoxon signed-rank for continuous data, and Chi-square or fisher’s exact test for categorical data. Due to variance in CDMR definitions, we applied two accepted definitions of CDMR to compare the CDMR rates and associated factors with our primary CDMR definition (BORN). Results: Prevalence of CDMR in Ontario was stable over 5 years at 3.01%, with 1.77% being primary CDMR. Review of sociodemographic, obstetrical/neonatal and hospital factors between CDMR and non-CDMR showed that older women, higher education, caucasian, nulliparous, IVF conception, anxiety, and delivery at maternal hospital LOCIIc were more likely to have CDMR in this cohort. Conclusions: Using a provincial database, we were able to identify trends of CDMR. There needs to be consistency in definitions of CDMR to allow surveillance strategies. Key Words: CDMR, caesarian section
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O-OBS/GYN-069.....................................................................
DEFINITION AND INDICATORS OF MATERNAL NEAR MISS/SEVERE MATERNAL MORBIDITY: A SYSTEMATIC REVIEW Natalie England, Julia Madill, Amy Metcalfe, Stephanie Cooper, Charleen Salmon, Kamala Adhikari University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Calgary, T2N 4N1 Objectives: There continues to be international interest in monitoring maternal near miss (MNM)/severe maternal morbidity (SMM) as an adjunct to research on maternal mortality. In contrast to the universal agreement in the importance of this entity, there is widespread variability in the term itself and which indicators should be used to monitor these events. This systematic review aimed to summarize both the terms and indicators that are being used regarding this concept. Methods: In June 2018, we systematically searched Medline, EMBASE, and CINAHL for research on MNM/SMM. We included papers that used at least 3 indicators to evaluate MNM/SMM in pregnancy, delivery, and/or the puerperium. Results: Our initial search yielded 18,832 articles, of which 178 were included in the review. Of these papers, 38.76% (69/178) used the term SMM, 34.27% (61/178) used MNM, and the remaining 26.97% (48/178) used a different term. For monitoring, 37.64% (67/178) used indicators recommended by the World Health Organization (WHO), 7.30% (13/178) used indicators recommended by the Centers for Disease Control (CDC), 26.97% (48/178) used indicators by previous authors, 8.99% (16/178) described the process for developing a unique set of indicators for their study, and 19.10% (34/178) did not provide information on why included indicators were chosen. Importantly, 98.31% (175/178) included hemorrhage/ related indicators, while only 4.49% (8/178) included psychosis/ related indicators. Conclusions: While there is clear interest in MNM/SMM, our review highlights current inconsistencies and shows there is an urgent need to standardize these entities to promote a concerted global effort in addressing MNM/SMM. Key Words: maternal near miss, severe maternal morbidity, severe acute maternal morbidity, severe maternal complication, severe maternal outcome, systematic review
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O-OBS-JM-067 ..........................................................................
CREATING COST CONSCIOUS RESIDENTS IN OBSTETRICS AND GYNECOLOGY: A RANDOMISED CONTROLLED TRIAL Allison Edwards, Fahrin Rawji, Maryna Yaskina, Sue Ross University of Alberta, Lois Hole Hospital for Women, Royal Alexandra Hospital, 10240 Kingsway Avenue NW, Edmonton, Alberta, Canada, T5H 3V9 Objectives: Residents have a professional obligation to the stewardship of healthcare resources yet there is a paucity of research on how to improve their cost-awareness. Rising health care expenditure has highlighted a critical need to improve education in this competency. This study aims to test if an educational module can teach residents to make cost-conscious management plans and reduce health care spending. Methods: All Canadian Obstetrics and Gynecology residents in 2017 were eligible for this randomised controlled trial. The study was administered online via REDCap. Interested residents were enrolled, stratified by level of training and block randomised. Residents completed a survey to determine their management of four obstetrical scenarios. The intervention group reviewed an educational module on cost-effective ordering prior to completing the survey; the control group had the option to review it after. The primary outcome was mean total expenditure as calculated from the survey. Student’s t-test was used to compare the mean total expenditure between the two groups. Results: 85 residents were enrolled, 63 residents completed study requirements (33 control and 30 intervention). Mean total expenditure was $291.03 CAD (95% confidence interval [CI] 259.38322.68) versus $192.98 CAD (95% CI 170.67-215.29) in the control and intervention groups respectively, corresponding to a 33.69% or $98.05 CAD (p=0.0001) reduction in total expenditure. Conclusions: This educational module decreased expenditure by Canadian Obstetrics and Gynecology residents in the management of hypothetical obstetrical cases. This introduces a potential curriculum innovation to improve resident education in judicious use of healthcare resources. Key Words: Health care costs, Resource allocation, Cost control
&
O-OBS-MD-125 ........................................................................
CAESAREAN DELIVERY ON MATERNAL REQUEST IN ONTARIO: TRENDS AND DETERMINANTS Darine El-Chaar, Yanfang Guo, Daniel Corsi, Ruth White, Laura Gaudet, Mark Walker, Shi Wu Wen Ottawa Hospital Research Institute, 1967 Riverside Drive, 7th Floor, Ottawa, Ontario, Canada, K1H7W9 Objectives: Explore trends of Caesarean Delivery on Maternal Request (CDMR) in Ontario and the association between maternal socio-demographic, obstetric/neonatal, hospital factors and CDMR. We also reviewed differences in trends by differing terminology of CDMR. Methods: A population−based cohort study using BORN perinatal database (2012-2016, N= 668,468). After excluding labouring women, multiple gestations and women with indicated risks against labor, 5,576 CDMR cases remained. We used "maternal request" to indicate CDMR. Those not recorded as "maternal request" were categorized as "non-CDMR". Summary statistics were generated to describe population characteristics. Differences in socio-demographic, medical/obstetric/neonatal and hospital factors between CDMR and non-CDMR were compared. Continuous variables are
716
MAY JOGC MAI 2019
described by mean§SD or median(IQR). Categorical variables are described by count and percentage. Comparisons between CDMR and non-CDMR are performed by t-test or Wilcoxon signed-rank for continuous data, and Chi-square or fisher’s exact test for categorical data. Due to variance in CDMR definitions, we applied two accepted definitions of CDMR to compare the CDMR rates and associated factors with our primary CDMR definition (BORN). Results: Prevalence of CDMR in Ontario was stable over 5 years at 3.01%, with 1.77% being primary CDMR. Review of sociodemographic, obstetrical/neonatal and hospital factors between CDMR and non-CDMR showed that older women, higher education, caucasian, nulliparous, IVF conception, anxiety, and delivery at maternal hospital LOCIIc were more likely to have CDMR in this cohort. Conclusions: Using a provincial database, we were able to identify trends of CDMR. There needs to be consistency in definitions of CDMR to allow surveillance strategies. Key Words: CDMR, caesarian section
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O-OBS/GYN-069.....................................................................
DEFINITION AND INDICATORS OF MATERNAL NEAR MISS/SEVERE MATERNAL MORBIDITY: A SYSTEMATIC REVIEW Natalie England, Julia Madill, Amy Metcalfe, Stephanie Cooper, Charleen Salmon, Kamala Adhikari University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Calgary, T2N 4N1 Objectives: There continues to be international interest in monitoring maternal near miss (MNM)/severe maternal morbidity (SMM) as an adjunct to research on maternal mortality. In contrast to the universal agreement in the importance of this entity, there is widespread variability in the term itself and which indicators should be used to monitor these events. This systematic review aimed to summarize both the terms and indicators that are being used regarding this concept. Methods: In June 2018, we systematically searched Medline, EMBASE, and CINAHL for research on MNM/SMM. We included papers that used at least 3 indicators to evaluate MNM/SMM in pregnancy, delivery, and/or the puerperium. Results: Our initial search yielded 18,832 articles, of which 178 were included in the review. Of these papers, 38.76% (69/178) used the term SMM, 34.27% (61/178) used MNM, and the remaining 26.97% (48/178) used a different term. For monitoring, 37.64% (67/178) used indicators recommended by the World Health Organization (WHO), 7.30% (13/178) used indicators recommended by the Centers for Disease Control (CDC), 26.97% (48/178) used indicators by previous authors, 8.99% (16/178) described the process for developing a unique set of indicators for their study, and 19.10% (34/178) did not provide information on why included indicators were chosen. Importantly, 98.31% (175/178) included hemorrhage/ related indicators, while only 4.49% (8/178) included psychosis/ related indicators. Conclusions: While there is clear interest in MNM/SMM, our review highlights current inconsistencies and shows there is an urgent need to standardize these entities to promote a concerted global effort in addressing MNM/SMM. Key Words: maternal near miss, severe maternal morbidity, severe acute maternal morbidity, severe maternal complication, severe maternal outcome, systematic review