how can we achieve consensual indicators to be better accepted and more widely used?
TRANSCRIPT
European Journal of Obstetrics & Gynecology and Reproductive Biology 173 (2014) 123–124
LETTERS TO THE EDITOR—CORRESPONDENCE
Contents lists available at ScienceDirect
European Journal of Obstetrics & Gynecology andReproductive Biology
jou r nal h o mep ag e: w ww .e lsev ier . co m / loc ate /e jo g rb
How can we achieve consensual indicators to bebetter accepted and more widely used?
Dear Editor,
We really appreciated the letter [1] and editorial [2]that followed our recent publication [3]. The argumentsthat were brought up by both the Euro-Peristat scientificcommittee and Russell Kirby were pertinent and relevant for thedefinition and development of health care indicators, especiallyhaving in mind the monitoring of perinatal healthcare withinEurope.
We also believe in the crucial importance of using a scientificapproach in the development and monitoring of indicators [2].The definition of a set of consensual indicators for a wide range ofstakeholders should also be encouraged [1,2]. After a complexprocess of gathering and reviewing perinatal data and indicators,the Euro-Peristat program tried to address these two issues,mostly using a modified DELPHI process in order to achieveconsensus between two groups of experts from 15 differentEuropean countries: the first, the scientific advisory committee ofthe Euro-Peristat program, comprising 27 clinicians, epidemiol-ogists and statisticians and the second, comprising 15 midwives[4]. The formality (and related costs) of this approach contrastsheavily with the simplicity of the methods and resources used inour ad hoc survey of scientific leaders in perinatal medicine.Nevertheless, our study collected opinions from 134 perinatalexperts working in 21 European countries, 84% of whom wereclinicians and 14% non-physicians researchers. In addition, 26% ofthem were heads of their own hospital and/or academicdepartments [3].
In this context, a number of questions can be raised.Firstly, when addressing the choice of indicators, why should
consensus among the different stakeholders be necessarily betterthan dissensus? Or, in other words, why could some indicatorsnot be approved only by a particular group of stakeholders, evenif they are unable to reach a wide consensus? In fact andrather ironically, it may happen that an indicator that wasindeed able to reach a wide consensus among a mixed group ofexperts may not prove to be necessarily useful, in practice, toany specific group of stakeholders. It may be therefore useful todefine a particular set of indicators for a specific group ofstakeholders.
Secondly, why should the views of a fairly large group ofhighly motivated and knowledgeable experts (mostly clinicians,including 34 heads of department) be necessarily of lesser valuethan those arising from a DELPHI consensus group, involving asmaller group of experts where clinicians are also highly
DOIs of original articles: http://dx.doi.org/10.1016/j.ejogrb.2013.08.019, http://
dx.doi.org/10.1016/j.ejogrb.2013.09.033
0301-2115/$ – see front matter � 2013 Elsevier Ireland Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.ejogrb.2013.11.013
represented? In fact, the voices of opinion makers closelyinvolved in perinatal care should be also taken into account,particularly if rules and recommendations issued from ECbodies, such as DG-SANCO [4], are to be successfully translatedinto improvements in healthcare.
Thirdly, how can eventual differences in opinion expressed byexperts in formal Delphi approaches [4] versus in ad hoc surveys [3]be reconciled? Definitely, a more effective two-way communica-tion process between the Euro-Peristat program and those workingdaily in perinatal medicine may be needed and should thus beencouraged. This reconciliation may be particularly relevant forEuropean organizations in order to strengthen their links with thestakeholders they represent, as a precondition to implement moreefficient policies.
Zeitlin et al. [4] pointed out that ‘‘a high quality Europeaninformation system can only be built on a foundation of goodlocal and national systems’’. This is by no means a simple andeasy task, but difficult problems can also lead to elegant andinnovative solutions. Surely, in the case of the developmentand monitoring of perinatal indicators, new approaches arewanted.
Finally, we thank Zeitlin et al. [1] for the correction regardingthe definition of the perinatal period, as recommended by WHO.
References
[1] Zeitlin J, Mohangoo A, Macfarlane A, et al. The Euro-Peristat ScientificCommittee Building a European perinatal health information system:plurality, innovation and realism. Eur J Obstet Gynecol Reprod Biol2013;171:193–4.
[2] Kirby RS. Perinatal quality indicators: yardsticks for quality of care, measures ofpopulation health. Eur J Obstet Gynecol Reprod Biol 2013;171:1–2.
[3] Santos JV, Correia C, Cabral F, Bernardes J, Costa-Pereira A, Freitas A. ShouldEuropean perinatal indicators be revisited? Eur J Obstet Gynecol Reprod Biol2013;170:85–9.
[4] Zeitlin J, Wildman K, Breart G, et al. Selecting an indicator set for monitoringand evaluating perinatal health in Europe: criteria, methods and resultsfrom the PERISTAT project. Eur J Obstet Gynecol Reprod Biol 2003;111:S5–14.
Joao V. Santosa,b,*aDepartment of Health Information and Decision Sciences, Faculty of
Medicine, University of Porto, PortugalbCINTESIS – Center for Research in Health Technologies and
Information Systems, Portugal
Claudia CorreiaFilipe Cabral
Department of Health Information and Decision Sciences, Faculty of
Medicine, University of Porto, Portugal
Joao Bernardesa,b
aCINTESIS – Center for Research in Health Technologies and
Information Systems, Portugal
Letters to the Editor–Correspondence / European Journal of Obstetrics & Gynecology and Reproductive Biology 173 (2014) 123–124124
bDepartment of Obstetrics and Gynaecology, Faculty of Medicine,
University of Porto, Portugal
Alberto Freitasa,b
Altamiro Costa-Pereiraa,b
aDepartment of Health Information and Decision Sciences, Faculty of
Medicine, University of Porto, PortugalbCINTESIS – Center for Research in Health Technologies and
Information Systems, Portugal
*Corresponding author at: Department of Health Information andDecision Sciences, Faculty of Medicine, University of Porto,
Portugal. Tel.: +351 225513622; fax: +351 225513623E-mail address: [email protected] (J.V. Santos)
14 November 2013Accepted 18 November 2013
http://dx.doi.org/10.1016/j.ejogrb.2013.11.013
Response to ‘How can we achieve consensualindicators to be better accepted and more widelyused?’
Dear Editors,
We appreciate Santos and his co-authors’ interest in generatingdebate on which perinatal health indicators should be monitoredin Europe. Unfortunately, their response does not address our mainconcern with their proposed indicators, namely the absence ofclear shared definitions and the feasibility of collecting comparabledata from existing health information systems.
DOIs of original articles: http://dx.doi.org/10.1016/j.ejogrb.2013.05.017, http://
dx.doi.org/10.1016/j.ejogrb.2013.11.013, http://dx.doi.org/10.1016/j.ejogrb.2013.
08.019, http://dx.doi.org/10.1016/j.ejogrb.2013.09.033§ We are grateful for this interesting correspondence, which is now closed. We
would also draw readers’ attention to the Editorial by Professor Kirby ‘‘Perinatal
quality indicators: Yardsticks for quality of care, measures of population health’’
[Eur. J. Obstet. Gynecol. Reprod. Biol. 171 (2013) 1–2].
The fact that an item is of interest or importance is no guaranteethat it has an agreed definition or that it is feasible to collect dataon the subject. Euro-Peristat placed a high priority on comparabil-ity and feasibility in order to show that European surveillance ofperinatal health is an achievable goal despite the differences ofcurrent routine data systems. This approach has been successful, aswitnessed by the wealth of data on the care and health of pregnantwomen and newborns now available in the European PerinatalHealth Reports for the years 2004 and 2010.
We trust that the efforts by our scientific advisors and dataproviders in 29 countries to compile these data will serve as astimulus to move towards a more complete, flexible andinformative perinatal information system in Europe.
Jennifer Zeitlin*
Ashna MohangooAlison Macfarlane
Marina CuttiniMarie Delnord
Mika GisslerBeatrice Blondel
Sophie AlexanderHenrique Barros
the Euro-Peristat Scientific Committee
*Corresponding author at: INSERM, UMRS 953,Epidemiological Research Unit on Perinatal and Women’s and
Children’s Health, 53 avenue de l’Observatoire, 75014 Paris, France.Tel.: +33 1 42 34 55 83
E-mail address: [email protected] (J. Zeitlin)
http://dx.doi.org/10.1016/j.ejogrb.2013.12.007