Integrated birth care: a Triple Aim : Quality of birth centre care in the Netherlands

Growing demand for health services, fragmentation of services, changing health needs, and increasing influence of economic, political and social factors on health care delivery are steering policymakers to “integrated care” as a way to reduce costs, improve quality of care, and generate better patient outcomes. Birth centres are considered to be ideal settings for the realization of integrated care in the Dutch maternity care system and are assumed to offer better quality of care. Although evidence is available on the effectiveness of integrated care in chronic care, until now, there is no evidence for this assumption in birth care, even while current government policy in the Netherlands is based on it. Because birth centres are a relatively new phenomenon in Dutch maternity care, up until now there were no studies of the nature and degree of integration of birth centres in the Netherlands or data about their quality of care. The Dutch Birth Centre Study was designed to evaluate the performance of birth centres and their possible added value to the quality of Dutch maternity care. It presents evidence-based recommendations for organization and functioning of future birth centres. The study provided three theses which are closely connected but focus on different aspects of birth centre care. The present thesis focuses on the organization of birth centres and related aspects on quality and integrated care. The aim of this thesis was to describe the development and use of structure and process quality indicators for birth centres in the Netherlands and their level of integration, and to explore the assumption that more integrated birth centres can provide higher quality of care. This thesis includes the study design of the Dutch Birth Centre Study, the development of a definition of birth centres in the Netherlands, and the identification and description of these centres. It also describes the development of structure and process birth centre quality indicators and the assessment of birth centres using these indicators. Besides, it describes the development of a taxonomy that specifies key features of integrated primary care based on the Rainbow Model of Integrated Care, the assessment of integration profiles of birth centres and Maternity Care Networks (VSV’s) and the validation process of the Integration Questionnaire, used by the assessments. Finally, this thesis explores the hypothesis of interdependence of the Triple Aim components (experience of care, perinatal outcomes and costs) and whether they are related to the integration profiles of birth centres.