Open Access Study protocol

SIMPLE: implementation of recommendations from international evidence-based guidelines on caesarean sections in the Netherlands. Protocol for a controlled before and after study

Sonja Melman1*, Ellen NC Schoorel1, Carmen Dirksen2, Anneke Kwee3, Luc Smits4, Froukje de Boer5, Madelaine Jonkers6, Mallory D Woiski7, Ben Willem J Mol8, Johannes PR Doornbos9, Harry Visser10, Anjoke JM Huisjes11, Martina M Porath12, Friso MC Delemarre13, Simone MI Kuppens14, Robert Aardenburg15, Ivo MA Van Dooren16, Francis PJM Vrouenraets17, Frans TH Lim18, Gunilla Kleiverda19, Paulien CM van der Salm20, Karin de Boer21, Marko J Sikkema22, Jan G Nijhuis1, Rosella PMG Hermens23 and Hubertina CJ Scheepers1

Author Affiliations

1 GROW- School for Oncology and Developmental Biology, Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, P.O. Box 5800, Maastricht, AZ, 6202, The Netherlands

2 Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, P.O. Box 5800, Maastricht, AZ, 6202, The Netherlands

3 Department of Obstetrics and Gynaecology, University Medical Hospital Utrecht, P.O. Box 85090, Utrecht, AB, 3508, The Netherlands

4 Department of Epidemiology, Caphri School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands

5 Department of Obstetrics and Gynaecology, University Medical Centre Groningen, P.O. Box 30001, Groningen, RB, 9700, The Netherlands

6 Department of Obstetrics and Gynaecology, Ruwaard van Putten Hospital, P.O. Box 777, Spijkenisse, GA, 3200, The Netherlands

7 Department of Obstetrics and Gynaecology, Radboud University Nijmegen, P.O. Box 9101, Nijmegen, HB, 6500, The Netherlands

8 Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, Amsterdam, DD, 1100, The Netherlands

9 Department of Obstetrics and Gynaecology, Zaans Medical Centre, P.O. Box 210, Zaandam, EE, 1500, The Netherlands

10 Department of Obstetrics and Gynaecology, Tergooi Hospital Blaricum, P.O. Box 10016, Hilversum, DA, 1201, The Netherlands

11 Department of Obstetrics and Gynaecology, Gelre Hospital, P.O. Box 9014, Apeldoorn, DS, 7300, The Netherlands

12 Department of Obstetrics and Gynaecology, Maxima Medical Centre, P.O. Box 7777, Veldhoven, MB, 5500, The Netherlands

13 Department of Obstetrics and Gynaecology, Elkerliek Hospital, P.O. Box 98, Helmond, AB, 5700, The Netherlands

14 Department of Obstetrics and Gynaecology, Catharina Hospital, P.O. Box 1350, Eindhoven, ZA, 5602, The Netherlands

15 Department of Obstetrics and Gynaecology, Orbis Medical Centre, P.O. Box 5500, Sittard, MB, 6130, The Netherlands

16 Department of Obstetrics and Gynaecology, St. Jans Hospital Weert, P.O. Box 29, Weert, AA, 6000, The Netherlands

17 Department of Obstetrics and Gynaecology, Atrium Medical Centre Parkstad, P.O. Box 4446, Heerlen, CX, 6401, The Netherlands

18 Department of Obstetrics and Gynaecology, Ijsselland Hospital, P.O. Box 690, Capelle a/d Ijssel, AR, 2900, The Netherlands

19 Department of Obstetrics and Gynaecology, Flevohospital, P.O. Box 3005, Almere, EG, 1300, The Netherlands

20 Department of Obstetrics and Gynaecology, Meander Medical Centre, P.O. Box 1502, Amersfoort, BM, 3800, The Netherlands

21 Department of Obstetrics and Gynaecology, Hospital Rijnstate, P.O. Box 9555, Arnhem, TA, 6800, The Netherlands

22 Department of Obstetrics and Gynaecology, ZG Twente, P.O. Box 7600, Almelo, SZ, 7600, The Netherlands

23 Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, P.O. Box 9101, Nijmegen, HB, 6500, The Netherlands

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Implementation Science 2013, 8:3  doi:10.1186/1748-5908-8-3

Published: 3 January 2013

Abstract

Background

Caesarean section (CS) rates are rising worldwide. In the Netherlands, the most significant rise is observed in healthy women with a singleton in vertex position between 37 and 42 weeks gestation, whereas it is doubtful whether an improved outcome for the mother or her child was obtained. It can be hypothesized that evidence-based guidelines on CS are not implemented sufficiently.

Therefore, the present study has the following objectives: to develop quality indicators on the decision to perform a CS based on key recommendations from national and international guidelines; to use the quality indicators in order to gain insight into actual adherence of Dutch gynaecologists to guideline recommendations on the performance of a CS; to explore barriers and facilitators that have a direct effect on guideline application regarding CS; and to develop, execute, and evaluate a strategy in order to reduce the CS incidence for a similar neonatal outcome (based on the information gathered in the second and third objectives).

Methods

An independent expert panel of Dutch gynaecologists and midwives will develop a set of quality indicators on the decision to perform a CS. These indicators will be used to measure current care in 20 hospitals with a population of 1,000 women who delivered by CS, and a random selection of 1,000 women who delivered vaginally in the same period. Furthermore, by interviewing healthcare professionals and patients, the barriers and facilitators that may influence the decision to perform a CS will be measured. Based on the results, a tailor-made implementation strategy will be developed and tested in a controlled before-and-after study in 12 hospitals (six intervention, six control hospitals) with regard to effectiveness, experiences, and costs.

Discussion

This study will offer insight into the current CS care and into the hindering and facilitating factors influencing obstetrical policy on CS. Furthermore, it will allow definition of patient categories or situations in which a tailor-made implementation strategy will most likely be meaningful and cost effective, without negatively affecting the outcome for mother and child.

Trial registration

http://www.clinicaltrials.gov webcite: NCT01261676