105 Budget impact analysis of aCTG in primary midwife-led care INTRODUCTION Value-based healthcare has recently emerged as a prominent movement within healthcare. Value-based healthcare aims to improve patient outcomes by coordinating care around individual patients’ values, needs and preferences while efficiently using healthcare resources and eliminating (often harmful) waste.1 A basic characteristic is that care is given in the setting with the greatest value: low complex care not in expensive settings (hospitals or specific hospital departments) by expensive care providers (medical specialists and specific nurses) but in settings with lower costs outside the hospital.2 In this way, value-based healthcare can be used as a tool to provide the best quality of care for patients and address a number of important challenges for the healthcare sector as well, such as the increased demand for healthcare services and, at the same time, capacity problems in hospitals and rising healthcare costs.1,3 Policy of the Dutch government aims at moving care from inhospital to out-of-hospital care settings, such as the home situation and primary care.4,5 An example of a value-based healthcare innovation where care is moved from a more specialised setting to a less specialised setting is the performance of an antenatal cardiotocography (aCTG) in primary midwife-led care (MLC) for specific indications.6 Until recently, aCTG was only conducted in obstetrician-led care (OLC) in a hospital setting. Recent technological developments in healthcare facilitated the performance of an aCTG in primary care by a trained midwife using a portable CTG system,7 which can be used at the pregnant woman’s home or in the midwifery practice. This is expected to decrease unnecessary referrals and resource use in women with normal aCTG outcomes because only women with a non-reassuring aCTG, who may be at high risk for adverse neonatal outcomes, will be referred to the hospital. Studies showed that referral from primary to secondary care is associated with lower satisfaction among pregnant women due to the lack of continuity of care.8,9 It is essential to ensure that the quality of care is not negatively affected when reorganising and shifting tasks and responsibilities. An important aspect of quality of care is safety. When implementing aCTG in primary care, safety and, thus, quality of care may be reduced if primary care midwives are less able to accurately classify aCTGs. However, a previous study showed excellent agreement between primary care midwives, hospital-based midwives, residents and obstetricians in the overall classification of aCTGs in healthy women.10 In a prospective study, we evaluated the process maternal and neonatal outcomes of aCTG in MLC (MLC-aCTG). A referral to secondary care was indicated after 13.0% MLC-aCTGs due to non-reassuring aCTGs, ultrasound abnormalities or other reasons, which means that 87% of these women did not need to be referred to the hospital where they normally would have received the aCTG in OLC (OLC-aCTG). The maternal and perinatal outcomes of women who had an MLC-aCTG were in the expected range for a low-risk population in MLC.11 Additionally, women were highly satisfied with the care they received.12 These outcomes together make MLC-aCTG a promising value-based healthcare innovation. Although we expect 5
RkJQdWJsaXNoZXIy MTk4NDMw