Natasha Donnolley

The development of a classification system for maternity models of care

Background: A lack of standard terminology or means to identify and define models of maternity care in Australia has prevented accurate evaluations of outcomes for mothers and babies in different models of maternity care. Objective: As part of the Commonwealth-funded National Maternity Data Development Project, a classification system was developed utilising a data set specification that defines characteristics of models of maternity care. Method: The Maternity Care Classification System or MaCCS was developed using a participatory action research design that built upon the published and grey literature. Results: The study identified the characteristics that differentiate models of care and classifies models into eleven different Major Model Categories. Conclusion: The MaCCS will enable individual health services, local health districts (networks), jurisdictional and national health authorities to make better informed decisions for planning, policy development and delivery of maternity services in Australia.

Vasa Praevia: a descriptive review of existing literature and the evolving role of ultrasound in prenatal screening

Introduction: Literature addressing the feasibility of prenatal detection of vasa praevia during the mid‐trimester morphology ultrasound scan is scarce, as is a lack of consensus about the appropriate management of pregnancies once it is detected.

A validation study of the Australian Maternity Care Classification System

BACKGROUND The Maternity Care Classification System is a novel system developed in Australia to classify models of maternity care based on their characteristics. It will enable large-scale evaluations of maternal and perinatal outcomes under different models of care independently of the models name. AIM To assess the accuracy, repeatability and reproducibility of the Maternity Care Classification System. METHOD All 70 public maternity services in New South Wales, Australia, were invited to classify three randomly allocated model case-studies using a web-based survey tool and repeat their classifications 4-6 weeks later. Accuracy of classifications was assessed against the correct values for the case-studies; repeatability (intra-rater reliability) was analysed by percent agreement and McNemars test between the same participants in both surveys; and reproducibility (inter-rater reliability) was assessed by percent agreement amongst raters of the same case-study combined with Krippendorffs alpha coefficient for a subset of characteristics. RESULTS The accuracy of the Maternity Care Classification System was high with 90.8% of responses correctly classified; was repeatable, with no statistically significant change in the responses between the two survey instances (mean agreement 91.5%, p>0.05 for all but one variable); and was reproducible with a mean percent agreement across 9 characteristics of 83.6% and moderate to substantial agreement as assessed by a Krippendorffs alpha coefficient of 0.4-0.8. CONCLUSION The results indicate the Maternity Care Classification System is a valid system for classifying models of care in Australia, and will enable the legitimate evaluation of outcomes by different models of care.

Assessment of the societal and individual preferences for fertility treatment in Australia: study protocol for stated preference discrete choice experiments

Introduction In Australia, societal and individual preferences for funding fertility treatment remain largely unknown. This has resulted in a lack of evidence about willingness to pay (WTP) for fertility treatment by either the general population (the funders) or infertile individuals (who directly benefit). Using a stated preference discrete choice experiment (SPDCE) approach has been suggested as a more appropriate method to inform economic evaluations of fertility treatment. We outline the protocol for an ongoing study which aims to assess fertility treatment preferences of both the general population and infertile individuals, and indirectly estimate their WTP for fertility treatment. Methods and analysis Two separate but related SPDCEs will be conducted for two population samples—the general population and infertile individuals—to elicit preferences for fertility treatment to indirectly estimate WTP. We describe the qualitative work to be undertaken to design the SPDCEs. We will use D-efficient fractional experimental designs informed by prior coefficients from the pilot surveys. The mode of administration for the SPDCE is also discussed. The final results will be analysed using mixed logit or latent class model. Ethics and dissemination This study is being funded by the Australian National Health and Medical Research Council (NHMRC) project grant AP1104543 and has been approved by the University of New South Wales Human Research Ethics Committee (HEC 17255) and a fertility clinic’s ethics committee. Findings of the study will be disseminated in peer-reviewed journals and presented at various conferences. A lay summary of the results will be made publicly available on the University of New South Wales National Perinatal Epidemiology and Statistics Unit website. Our results will contribute to the development of an evidence-based policy framework for the provision of cost-effective and patient-centred fertility treatment in Australia.