Public data: Supporting Midwifery Practices to Use and Share - PowerPoint PPT Presentation

Public data: Supporting Midwifery Practices to Use and Share Outcomes BORN Conference 2019, Ottawa Vicki Van Wagner, RM, PhD Shawna DiFilippo, SM, MA Ryerson University, Toronto Midwives Collective of Toronto 1

Context • Part of a larger project aimed at encouraging midwives to use BORN standardized reports for QI, interprofessional dialogue and for client education • We used data from BORN standardized reports to audit outcomes for a large urban midwifery practice to:  Answer questions important to midwives and clients  Promote public sharing of outcomes data within the midwifery community  Develop and share tools for understanding and sharing data from BORN midwifery standardized reports 2

The Midwives Collective of Toronto • Large urban practice in downtown west • 15-18 midwives attending 400-600 births/year • Privileges at Mount Sinai Hospital (Level III) • Full scope of practice • Continuity of care • Choice of birth place • Active teaching practice Williamsonwilliamson 3

Impact of the Toronto Birth Centre • Toronto Birth Centre (TBC) opened Feb 2014 adding a new choice of birth place for Toronto midwifery practices • The MCT implemented a new booking policy in 2015 which prioritized OOH births to allow practice growth in the context of a restricted hospital birth quota • We wanted to understand the impact on:  Client demographics  Place of birth  Rates of intervention and outcomes Angel Zhang ArcGIS 4

Background • Four Toronto midwifery practices participated in a research project that analyzed and compared outcomes using MOR data from MOHLTC for 2003-2007 • Publication in CJMRP: Perinatal Outcomes for Four Toronto Practices: Exploring Best Practices for Normal Birth • Answered important questions about impact on outcomes for practices with different scopes of practice • Midwives used this study to inform clients about their practice specific outcomes CJMRP, Vol 13, Issue 2, 2014 • We wanted an update for MCT: BORN allows us to compare many outcomes with this previous study 5

Poster created for an open house during the ICM Congress 2017 (International Confederation of Midwives) became a popular part of our waiting area and website Public data and client education in action using BORN data from midwifery reports 6

Data source • BORN standardized reports for 5 FYs: 2012/13 – 2016/17 • BIS > Reporting > Maternal Newborn Reports:  Midwifery Care Profile – Birth  Midwifery Care Profile – Demographics  Midwifery Care Profile – Labour  Midwifery Care Profile – Newborn Outcomes  Midwifery Care Profile – Utilization of Services • MCT outcomes compared with outcomes of Ontario midwifery clients overall; sub-analysis by parity for some indicators 7

2012/13 – 2016/17: MCT and ON midwifery quick facts Total MCT clients who gave Total Ontario midwifery clients who birth: 2,456 gave birth: 101,242 Average number of MCT clients Average number of ON MW clients who gave birth each year: 491 who gave birth each year: 20,248 Total midwife-attended out-of- Total MCT OOH births: 824 hospital (OOH) births: 18,721 Average MCT OOH birth Average midwifery OOH birth rate: 33.5% rate: 18.5% 5-year overall change in MCT 5-year overall change in ON MW OOH birth: 42.8% increase OOH birth: 6.4% decrease 8 Photo source: Kevin Liang on unsplash.com

Demographics Table 1.0: Client demographics, 5-year totals and averages (%) • Compared with ON MW clients Characteristic MCT All MPGs overall, MCT clients were more Parity Primiparous 1,224 (49.8%) 44,261 (43.7%) likely to be primiparous, ≥35 years, speak a primary language Multiparous 1,139 (46.6%) 56,739 (56.0%) other than English, and Missing 94 (3.8%) 261 (0.3%) uninsured. • Client parity has shifted since Age ≥35 yrs 893 (36.3%) 20,239 (20.0%) 2003-2007: primips = 40%, ≥40 yrs 153 (6.2%) 2,069 (2.6%) multips = 60%, uninsured = 5.6%. • Risk Singleton, term, vertex, 2,051 (83.5%) 81,771 (80.8%) Current demographics may be profile no prev uterine scar similar to other urban practices • Primary language other than Other Primary language other 196 (12.7%) 8,211 (8.6%) English likely higher than than English* reported. Uninsured 329 (13.1%) 7,795 (7.5%) Repeat client 808 (32.2%) 39,041 (37.6%) 9 *Based on data collected. On average, language data was missing for ~36% of MCT clients (vs ~6% for all MPGs).

Demographics • The proportion of MCT clients who are considered low- risk decreased, while remaining stable for ON MW Figure 1.0: Uninsured clients clients overall. This decrease among MCT clients 20.0 occurred alongside increasing OOH birth (booking policy 18.0 prioritizing OOH birth beginning 2015, and opening of 16.0 TBC in 2014) and continued strong outcomes. 14.0 12.0 Figure 1.1: Clients who fit low-risk* profile 10.0 % 88.0 8.0 6.0 86.0 Uninsured MCT 4.0 2.0 84.0 Uninsured all MPGs Feb 2014: TBC opens 0.0 % 82.0 2012/13 2013/14 2014/15 2015/16 2016/17 80.0 • MCT clients were twice as likely to be uninsured than ON MW clients 78.0 Low-risk MCT • There was greater percentage of uninsured clients in 76.0 Low-risk all MPGs 2012/13 for both MCT and MW clients generally 74.0 possibly related to cuts to IFHP 2012/13 2013/14 2014/15 2015/16 2016/17 *Low-risk: singleton, vertex, term, no previous uterine scar. 10

Table 2.0: Place of birth, planned vs actual, 5-year totals and averages (%) Place of birth Location MCT All MPGs Figure 2.0: OOH birth, planned vs actual Tot hosp 1,304 77,710 (76.6%) 60.0 (53.1%) 50.0 Tot OOH 1,152 23,530 (23.2%) Planned total OOH Planned birth - MCT (46.9%) 40.0 Planned total OOH Home 632 (25.7%) 19,385 (19.1%) % birth - all MPGs 30.0 Actual total OOH BC 500 (20.4%) 2,917 (2.9%) 20.0 birth - MCT Other 20 (0.8%) 1,228 (1.2%) Actual total OOH 10.0 birth - all MPGs Total 1,632 82,521 (81.4%) Feb 2014: TBC opens 0.0 hosp (66.4%) 2012/13 2013/14 2014/15 2015/16 2016/17 • More MCT clients planned/gave birth OOH than ON MW clients Tot OOH 824 (33.6%) 18,721 (18.5%) Actual • OOH births declined slightly in ON since 2003- 07 22% ↓ 18.5% Home 561 (22.8%) 16,531 (16.3%) • MCT OOH births remained stable between 2003-2007 and 2012/13 BC 262 (10.7%) 1,550 (1.5%) • MCT OOH births have increased each year since the opening of Other 1 (0.0%) 640 (0.6%) the TBC from 28.3% in 2012/13 to 40.4% in 2016/17 11

Place of birth Figure 2.2: MCT OOH births, planned vs actual Figure 2.1: MCT hospital births, planned vs actual 60.0 80.0 50.0 70.0 40.0 60.0 30.0 % Planned OOH 50.0 20.0 Actual OOH 40.0 Hospital - planned - 10.0 % overall Feb 2014: TBC opens 30.0 0.0 Hospital - actual - 20.0 overall 10.0 Feb 2014: TBC opens 0.0 2012/13 2013/14 2014/15 2015/16 2016/17 • MCT’s hospital births decreased substantially with the opening of the TBC by almost 30% for planned hospital, and by almost 17% for actual over the 5 years. • The most dramatic increases in OOH birth were among primips: a 42% increase in planned OOH, and a 32% increase in actual OOH. Of interest, TBC births were more likely to be planned by primips, and the MCT policy of prioritizing OOH birth was for first-time clients only, who are more likely to be primips. 12

MCT OOH birth Figure 2.3: MCT home births, planned vs actual Figure 2.4: MCT birth centre birth, planned vs actual 40.0 40.0 Home - Birth centre - 35.0 35.0 planned planned 30.0 30.0 Home - actual Birth centre - 25.0 25.0 actual 20.0 % 20.0 % 15.0 15.0 10.0 10.0 5.0 5.0 Feb 2014: TBC opens 0.0 Feb 2014: TBC opens 0.0 • Among MCT clients, planned home births were more likely to result in actual home births, whereas there was a greater difference between those planned and actual birth centre births. This may have to do with different client characteristics of those choosing home vs. TBC births. • In 2016/17, actual home births exceeded actual TBC births. • It would appear that the increase in TBC births among MCT clients ‘came’ from both a decrease in hospital 13 and home births, although this may be leveling off for home births in the most recent analyzed.

Place of birth: parity (MCT) Table 2.1 (cont’d): MCT clients’ OOH births, Table 2.1: MCT clients’ place of birth, planned vs planned vs actual, 5-year totals and averages (%) actual, 5-year totals and averages (%) Location MCT Planned MCT Actual Location MCT Planned MCT Actual Home 632 (25.7%) 561 (22.8%) Hospital 1,304 (53.1%) 1,632 (66.4%) Primip 287 (23.2%) 223 (18.0%) Primip 596 (48.2%) 866 (70.1%) Multip 345 (28.3%) 338 (27.7%) Multip 707 (58.0%) 765 (62.8%) Birth centre 500 (20.4%) 262 (10.7%) OOH 1,152 (46.9%) 824 (33.6%) Primip 344 (27.8%) 147 (11.9%) Primip 640 (51.8%) 370 (29.9%) Multip 156 (12.8%) 115 (9.4%) Multip 512 (42.0%) 454 (18.5%) Other* 20 (0.8%) 1 (0.1%) • Of clients planning OOH births, multips were more likely to plan home births and primips TBC births. Primip 9 (0.7%) 0 (0.0%) • The association between parity and choice of OOH birth Multip 11 (0.9%) 1 (0.1%) location helps explain why transfer rates were higher for TBC than planned home births *Could include clinic births or undecided. 14