Program of Research for the Optimization of a Supervised Patient Pathway for Expectant According to Risk in Obstetrics

Study Overview
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Brief Summary
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This French multicentre open-label randomized trial will test the hypothesis that a coordinated health circuit based on obstetric risks, backed up by an electronic patient care reporting information system will optimize the continuum of pregnancy care monitoring. The electronic patient care reporting information system will be shared between patients, private practice physicians/midwifes, hospital physicians/midwifes and supervised by a coordinating midwife.

Official Title
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Program of Research for the Optimization of a Supervised Patient Pathway for Expectant According to Risk in Obstetrics

Conditions
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Pregnancy

Intervention / Treatment
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* Behavioral: PROSPERO
* Other: control


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients over the age of majority, enrolled in one of the two maternity hospitals in the study before 12 weeks of amenorrhea (SA) and 6 days (j) of age, affiliated to the National Health Insurance Fund of the country within the regional level health insurance have an internet access Exclusion Criteria: illiterate patients, non-French speakers, under the age of majority, refusing to participate, without internet access, followed by one of these maternity wards but delivering else where, whose pregnancy ended in a miscarriage early or late (before 21 weeks of amenorrhea (SA) and 6 days (J) over).

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: PROSPERO group (intervention group)<br> | Behavioral: PROSPERO<br>* The intervention is carried out in 3 steps: At the start of the pregnancy: a number of process steps are defined for a patient's pathway adapted to medical, obstetric and social risk factors. During pregnancy: city based doctors and midwives work together with their hospital peers enabling patients to participate through the reporting via a medical information system The entrance in the delivery room: patients are classified as low or high risk for greater vigilance from midwives.<br>|
| Placebo Comparator: control group<br> | Other: control<br>* At the start of the pregnancy, medical, obstetric and social risk factors are checked in the same way than the PROSPERO group. An adapted patient pathway was defined by a Clinical Research Assistant but unreachable from patients, midwifes and physicians. The electronic patient care reporting information system will be disabled and midwifes cannot create the classification checklist for low or high risk delivery.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of patients'pathway approved as compliant in the intervention group compared to the control group. | Compliant patient pathways are those for which all actions (medical visits, examinations, …) recommended during pregnancy, according to the specific risk factors of each patient, will have been made. | at the end of pregnancy | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| rate of severe maternal morbidity and mortality as defined by the EPIdémiologie de la MOrbidité Maternelle Sévère (EPINOMS) project |  | From 22 completed weeks (154 days) of gestation to seven completed days after birth | 
| rate of perinatal morbidity-mortality as defined by the Organization, Practices Evaluation in perinatal Network |  | From 22 completed weeks (154 days) of gestation to seven completed days after birth | 
| completeness of all hospital medical records | completeness of hospital medical records compared to electronic patient-reported outcome (ePRO). | the end of pregnancy (the date of delivery) | 
| health care costs | Number of medical visits and hospitalization | one week from the date of delivery | 
| health care costs | duration of medical visits and hospitalization | one week from the date of delivery | 
| patients' satisfaction : Qualitative evaluation by interview | Qualitative evaluation of patients' satisfaction and adherence by interview and/or focus groups. Quantitative evaluation of patients' satisfaction and anxiety by the hospital anxiety and depression scale and other validated's patient satisfaction forms | at the end of pregnancy | 
| patients' satisfaction : Quantitative evaluation by the hospital anxiety and depression scale | Quantitative evaluation of patients' satisfaction and anxiety by the hospital anxiety and depression scale | at the end of pregnancy | 
| patients' satisfaction : Qualitative evaluation by interview | Qualitative evaluation of patients' satisfaction and adherence by interview and/or focus groups. | within one week from the date of delivery | 
| patients' satisfaction : Quantitative evaluation by the hospital anxiety and depression scale | Quantitative evaluation of patients' satisfaction and anxiety by the hospital anxiety and depression scale and other validated's patient satisfaction forms | within one week from the date of delivery | 
| types of delivery | rate of vaginal delivery, instrumental extraction delivery, Caesarean delivery | within one week from the date of delivery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Clinical pathway, Electronic Health Records, Maternal Health Services & administration, Patient Access to Records, Patient Satisfaction, Prenatal Care/methods