Hans van den Heuvel

A critical evaluation of emerging technologies in the field of prenatal care is necessary to determine itsaddedvalue in futurecaremodels. Thisviewpoint is in linewith theDutchHealth Ministries’ program ”Outcome based healthcare 2018-2022” stating four central objectives: more insight into outcomes, more shared- decision making, organisation and funding of care focused on outcomes; and better access to relevant and up-to-date outcomes information. 32 As a result of this program, multiple initiatives within pregnancy and childbirth care have been established. One of the examples, the BUZZ project, is conducted in pregnancy in seven regions in the Netherlands and aims to implement shared decision making with help of PROMs using the International Consortium of Health Outcome Measurement (ICHOM) Pregnancy and Childbirth standard outcome set. 33,34 The field of pregnancy and childbirth care in the Netherlands promotes and advances integrated (birth) care. 35 Care is increasingly offered by a continuum of services, crossing the boundaries of the different compartments of primary, secondary of tertiary care. Evidence shows that integrated care reduces costs with improvement of quality of care and patient outcomes. 36 In general a shift of care to lower levels of specialization is observed: from (tertiary) hospital care, to general practioner, to practice nurse, of self-care. In the Netherlands this movement is known by the name “Right care at the right place”. The use of digital health can aid in the downscaling of pregnancy care delivery too. With help of our digital platform, daily measurement from home are sorted by midwives and obstetric nurses, before abnormal results are to be evaluated by physicians. An integrated approach including telemonitoring in pregnancy can also result in more efficient, accessible and patient-friendly care. 37 Future implications Insights provided by this thesis on the results of digital care on perinatal outcomes, patient experiences and cost comparisons can be a starting point for future practice and research. In line with the triple aim of improvement of health care, a division can be made in to experienced quality of care, healthcare outcomes and impact on costs. In general, we found that the use of digital care can enhance the experienced quality of care perceived by pregnant women. The involvement of pregnant women in future care strategies on blended care seems essential for increased uptake and implementation in care. Therefore, in each stage of development, research or implementation, end-users must be actively engaged. Research with both quantitative and qualitative methodologies can provide valuable answers for tailored care. To assess the participation of all stakeholders in a novel strategy of care enhancedwith digital health, implementation science will play a crucial role. Future evaluations of implementing digital health will find barriers and facilitators from all perspectives (i.e. patients, care professionals, other hospital personnel, patient associations and financial experts). With help of the results of implementation research, future care can benefit from sustainable CHAPTER 11 188