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Theory and methods for evidence based perinatal health care and policy in cross-national studies

Final Report Summary - PERINATAL HEALTHCARE (Theory and methods for evidence based perinatal health care and policy in cross-national studies)


Over the past 10 years, my research at the Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, INSERM U953, has focused on assessing the impact of the organisation of care on the health of pregnant women and babies. Our studies documented disparities in maternal and infant health outcomes between regions and countries of Europe with similar socioeconomic status and access to medical technology. They also found extreme variability in the organisation of health care and use of medical procedures, which raised questions about the efficacy of these approaches to health service provision. The general aim of this fellowship was to strengthen my research programme by integrating knowledge from the field of health services research. The fellowship is carried out with the Department of Health Evidence and Policy at Mount Sinai Medical Center in New York City (supervisor, Pr. A Gelijns) and INSERM (supervisor: Pr. G Breart).

My specific objectives were to:

1.Acquire knowledge about theory and methods from specialists in health services research to be integrated into my epidemiological research programme.
2.Develop methods for the study of the comparative organisation of perinatal care with a focus on study design, data collection protocols and statistical analysis.
3.Obtain an understanding of the organisation of health services research in the United States.
4.Develop a network of contacts with health services researchers for the development of future collaborative projects

The work performed since the beginning of the project as specified in the work plan included:

1.Review of cross-national studies to evaluate the methods used to analyse variability in outcomes and care. The aim of this literature review was to provide a contextual background for the work carried out in the fellowship.
2.Develop protocols for measuring quality and methods for data analysis for new research projects with researchers in the US and France.
3.Design a doctoral level course on health services research (participate in seminars during the outgoing phase and interact with researchers to identify seminal works for a review course on health services research).
4.Bring together European and French researchers to build capacity for research on evidence based obstetric and neonatal care and the multidisciplinary research agenda to be developed on this topic.
5.Use the protocol and methods developed during the outgoing phase to form the basis for a research project on very preterm infants with French and European partners
6.Develop the applications for health services research at my host institution, Inserm, in collaboration with other French and European specialists. The aim is to promote studies on healthcare quality and effectiveness and to provide training for young researchers. Contacts made with researchers in the US during the fellowship would reinforce the international dimension of this group.
7.Present results in US and European meetings and conferences.

Main results

During this fellowship, I developed collaborations with researchers in the Department of Health Evidence and Policy at Mt Sinai. These projects focus on measuring hospital quality and the impact of quality on health outcomes. E. Howell and I received authorisation to link New York State Discharge Abstract Data to New York Vital Statistics Records to test the feasibility of obstetric quality indicators. We also prepared a proposal to identify hospital-level factors that affect quality for very low birthweight infants. I also participated in a project on paediatric quality measures (The mount sinai collaboration for advancing pediatric quality measures (CAPQuaM)) funded by AHRQ (PI- Dr Laurence Kleinman). Another project analysed differences in preterm birth between France and the US (with Pr. C Ananth, Columbia University).

The knowledge acquired in this fellowship provided support for 2 successful bids for European health services research projects on perinatal health - one financed by DG-Research and the other by DG-Sanco. The DG-Research project, 'Effective Perinatal Intensive Care in Europe: Translating knowledge into evidence-based practice' (EPICE), brings together researchers from 19 European regions to study how the organization of health services and, in particular, the use of medical practices based on scientific evidence, affects health outcomes. This project uses a mixed-methods approach with a population-based cohort study combined with qualitative studies. Dr. Howell from the Mount Sinai School of Medicine is a member of the external advisory board for this project. We hope to develop a project comparing these data with those constituted as part of our collaborative project on births in New York City. The EPICE project also includes quality measures that are part of the CAPQuaM collaboration (hypothermia control) and thus opportunities for continued collaboration exist with this project.

Over the course of the fellowship, I presented results in 3 invited lectures, 8 presentations/posters in European and US conferences. Six manuscripts have produced (5 submitted and 1 to be submitted by the end of 2012).

Conclusions and impact

In sum, this fellowship provided me with both the knowledge and the institutional ties that I needed to develop my research programme and gain more visibility in my field. These ties will endure beyond this fellowship as I retain a position of Adjunct Associate Professor in the Department of Health Evidence and Policy at the Mount Sinai School of Medicine. Upon my return to France, I have been able to develop courses reflecting my new expertise in this domain. Further, knowledge acquired during this fellowship made it possible to develop European research collaborations. These collaborations promote health services research to provide evidence for health policies with the ultimate aim of improving the health of mothers and babies in Europe.