190 Chapter 7 Governments, together with healthcare professionals, are faced with the challenge to address the current problems in healthcare: accessibility, affordability, and quality. Furthermore, care is increasingly being provided through a continuum of services that cross the boundaries of primary, secondary, and tertiary care to reduce discontinuities in care. In maternity care, the development of value-based innovations through the expansion of the practice of primary care midwives is providing solutions for optimizing prenatal care.1 VBHC has been introduced to provide care more efficiently and is defined by achieving the best patient outcomes at the lowest possible costs. To this end, organizations need to reduce costs without compromising quality and, on the other hand, they need to increase quality without increasing costs. Note that this is a patient-centered perspective: the patient’s experience of value is the goal.2 In light of the VBHC strategy, the studies in this thesis were carried out as an evaluation of both the quality (i.e., perinatal outcome, experiences of participants) and the costs of a new care pathway model for women in MLC with a specific aCTG indication. The overall aim of this thesis was to assess the value of care for women receiving an aCTG in primary care practices instead of in hospital-based care. We expressed the value of care in terms of measures of clinical outcomes, women’s experiences, and healthcare costs. Furthermore, we explored how, for whom, under what circumstances, and why an innovation such as MLC-aCTG can be implemented in high-income countries. Considering the current literature and developments in the healthcare landscape, we reflect on the implications of our work for the use of MLCaCTG and for further directions towards value-based maternity care. MAIN FINDINGS Quality of care Quality of care has been identified as one of the key components of operationalizing VBHC. Insight into outcomes, both clinical and patient-reported experiences, can facilitate informed decision-making. Furthermore, underuse, overuse, and misuse of medicine must be avoided when introducing a new pathway of healthcare.3,4 In this dissertation, several methods – a reliability study, a prospective cohort study, and a survey – were used to gain insight into the quality of MLC-aCTG.
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