The impact of caseload midwifery, compared with standard care, on women's perceptions of antenatal care quality

Survey results from the M@NGO randomized controlled trial for women of any risk

Jyai Allen, Sue Kildea, Mark B. Tracy, Donna L. Hartz, Alec W. Welsh, Sally K. Tracy

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: The measurement and interpretation of patient experience is a distinct dimension of health care quality. The Midwives @ New Group practice Options (M@NGO) randomized control trial of caseload midwifery compared with standard care among women regardless of risk reported both clinical and cost benefits. This study reports participants’ perceptions of the quality of antenatal care within caseload midwifery, compared with standard care for women of any risk within that trial.

Methods: A trial conducted at two Australian tertiary hospitals randomly assigned participants (1:1) to caseload midwifery or standard care regardless of risk. Women were sent an 89-question survey at 6 weeks postpartum that included 12 questions relating to pregnancy care. Ten survey questions (including 7-point Likert scales) were analyzed by intention to treat and illustrated by participant quotes from two free-text open-response items.

Results: From the 1748 women recruited to the trial, 58% (n = 1017) completed the 6-week survey. Of those allocated to caseload midwifery, 66% (n = 573) responded, compared with 51% (n = 444) of those allocated to standard care. The survey found women allocated to caseload midwifery perceived a higher level of quality care across every antenatal measure. Notably, those women with identified risk factors reported higher levels of emotional support (aOR 2.52 [95% CI 1.87-3.39]), quality care (2.94 [2.28-3.79]), and feeling actively involved in decision-making (3.21 [2.35-4.37]).

Conclusions: Results from the study show that in addition to the benefits to clinical care and cost demonstrated in the M@NGO trial, caseload midwifery outperforms standard care in perceived quality of pregnancy care regardless of risk.

Original languageEnglish
Pages (from-to)439-449
Number of pages11
JournalBirth
Volume46
Issue number3
Early online date23 Jun 2019
DOIs
Publication statusPublished - Sep 2019

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Group Practice
Prenatal Care
Midwifery
Randomized Controlled Trials
Quality of Health Care
Standard of Care
Pregnancy
Surveys and Questionnaires
Tertiary Care Centers
Postpartum Period
Cost-Benefit Analysis
Decision Making
Emotions
Costs and Cost Analysis

Cite this

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title = "The impact of caseload midwifery, compared with standard care, on women's perceptions of antenatal care quality: Survey results from the M@NGO randomized controlled trial for women of any risk",
abstract = "Background: The measurement and interpretation of patient experience is a distinct dimension of health care quality. The Midwives @ New Group practice Options (M@NGO) randomized control trial of caseload midwifery compared with standard care among women regardless of risk reported both clinical and cost benefits. This study reports participants’ perceptions of the quality of antenatal care within caseload midwifery, compared with standard care for women of any risk within that trial. Methods: A trial conducted at two Australian tertiary hospitals randomly assigned participants (1:1) to caseload midwifery or standard care regardless of risk. Women were sent an 89-question survey at 6 weeks postpartum that included 12 questions relating to pregnancy care. Ten survey questions (including 7-point Likert scales) were analyzed by intention to treat and illustrated by participant quotes from two free-text open-response items. Results: From the 1748 women recruited to the trial, 58{\%} (n = 1017) completed the 6-week survey. Of those allocated to caseload midwifery, 66{\%} (n = 573) responded, compared with 51{\%} (n = 444) of those allocated to standard care. The survey found women allocated to caseload midwifery perceived a higher level of quality care across every antenatal measure. Notably, those women with identified risk factors reported higher levels of emotional support (aOR 2.52 [95{\%} CI 1.87-3.39]), quality care (2.94 [2.28-3.79]), and feeling actively involved in decision-making (3.21 [2.35-4.37]). Conclusions: Results from the study show that in addition to the benefits to clinical care and cost demonstrated in the M@NGO trial, caseload midwifery outperforms standard care in perceived quality of pregnancy care regardless of risk.",
keywords = "antenatal care, midwifery, randomized controlled trial, survey",
author = "Jyai Allen and Sue Kildea and Tracy, {Mark B.} and Hartz, {Donna L.} and Welsh, {Alec W.} and Tracy, {Sally K.}",
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The impact of caseload midwifery, compared with standard care, on women's perceptions of antenatal care quality : Survey results from the M@NGO randomized controlled trial for women of any risk. / Allen, Jyai; Kildea, Sue; Tracy, Mark B.; Hartz, Donna L.; Welsh, Alec W.; Tracy, Sally K.

In: Birth, Vol. 46, No. 3, 09.2019, p. 439-449.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Tracy, Sally K.

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AB - Background: The measurement and interpretation of patient experience is a distinct dimension of health care quality. The Midwives @ New Group practice Options (M@NGO) randomized control trial of caseload midwifery compared with standard care among women regardless of risk reported both clinical and cost benefits. This study reports participants’ perceptions of the quality of antenatal care within caseload midwifery, compared with standard care for women of any risk within that trial. Methods: A trial conducted at two Australian tertiary hospitals randomly assigned participants (1:1) to caseload midwifery or standard care regardless of risk. Women were sent an 89-question survey at 6 weeks postpartum that included 12 questions relating to pregnancy care. Ten survey questions (including 7-point Likert scales) were analyzed by intention to treat and illustrated by participant quotes from two free-text open-response items. Results: From the 1748 women recruited to the trial, 58% (n = 1017) completed the 6-week survey. Of those allocated to caseload midwifery, 66% (n = 573) responded, compared with 51% (n = 444) of those allocated to standard care. The survey found women allocated to caseload midwifery perceived a higher level of quality care across every antenatal measure. Notably, those women with identified risk factors reported higher levels of emotional support (aOR 2.52 [95% CI 1.87-3.39]), quality care (2.94 [2.28-3.79]), and feeling actively involved in decision-making (3.21 [2.35-4.37]). Conclusions: Results from the study show that in addition to the benefits to clinical care and cost demonstrated in the M@NGO trial, caseload midwifery outperforms standard care in perceived quality of pregnancy care regardless of risk.

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