Project Registration

Project registration information

• Scientific Research Project Number: 2008 010
• Place: AMC, department Medical Informatics and department Obstetrics & Gynaecology
• Period: November 2008 - August 2009
• Student Name: Mark de Groot
• Student Number: 0455253

 

Project Information

Introduction

Perinatal mortality is an indicator of reproductive health and quality of obstetric healthcare. The European PERISTAT-1 study showed that perinatal mortality, and especially fetal mortality, is substantially higher in the Netherlands compared to other European countries [1]. In 1999 Dutch fetal mortality was 7.4 and early neonatal mortality 3.5 per 1000 births. The Dutch civil registration issued crude mortality data indicating a decline in Dutch perinatal mortality since 2000. Such a decline in mortality could be explained by a change in the prevalence of risk factors, by a change in the impact of these risk factors, by changes in healthcare factors or by a combination of these factors. However the civil registration has a limited set of risk factors for further analysis.

 

Recent research at the department of Medical Informatics on the national perinatal registration database (PRN-registry) found a trend in perinatal mortality; it has shown important regional differences in perinatal mortality and adverse pregnancy outcomes with worse outcomes in the northern part of the Netherlands (the more rural areas). These differences remained visible after adjusting for demographic or social-economical factors [2]. Other factors that might influence perinatal mortality and adverse outcomes are access to healthcare (travel time and travel distance) and use of healthcare (care-seeking behavior). Research has shown that regional variation in pregnancy outcomes can be related to population density, income level, social inequality, excess risk for certain conditions, access [3] and use of health services [4-7]. Therefore, the next step is to explore the role of travel time, travel distance and care-seeking behavior, both at the prenatal and delivery stage of care.

 

Difference in access to healthcare could be related to travel time to the hospital/midwife practice and to availability of healthcare services in the region. Therefore, in a new study we will focus on three factors: travel time, travel distance and care-seeking behavior. In this perspective, it is of interest to study if there are regional differences in both low risk term and post-term pregnancies (planned home/hospital delivery with a midwife) and in high risk pregnancies (and the referral process to secondary care during labor) in terms of adverse outcomes (defined later in this document).

 

The PRN

The Dutch Perinatal Registry (PRN) contains population based information on pregnancies, deliveries, fetal and neonatal death and (re)admissions occurring until 28 days after delivery or term date in case of prematurity. These national registries are the midwifery registry (LVR1), the obstetrics registry (LVR2) and the neonatology/pediatrics registry (LNR registry). The registries are linked at the department of Medical informatics of the AMC [2,8].

 

Project aim

The aim of this project is to analyze the linked national perinatal registry on relevant health questions. More specifically; the topic addresses how travel time & travel distance and care-seeking behavior affect adverse outcomes (adverse outcomes are defined as: perinatal mortality, congenital disorders, low Apgar score, NICU admission, dysmaturity and the intervention secondary caesarean section) in term pregnancies. This research is carried out within the framework of the PRN Registry. The work is performed at the Medical Informatics department at the AMC.

 

The problem

The project includes epidemiological studies on several adverse outcomes (defined earlier in this document) based on the linked Dutch perinatal registries. Travel time and travel distance will be calculated and it will be determined if these two factors affecting Dutch perinatal outcomes. The improvement in outcomes for the term population is important. Travel time and travel distance will be calculated and visualized by using ArcGIS Desktop, which is a geographical information system [9]. Geographical information systems are used in several studies [10,11] to calculate road distance and travel time for populations to several end points (for example healthcare centers); even public transport can be modeled in a geographical information system [12].

 

Research questions

• A. What is the relation between travel time & travel distance on adverse outcomes adjusted for maternal age, parity, ethnicity and deprivation?
• B. Does care-seeking behavior, defined as 'deciding to seek appropriate medical help for an obstetric emergency', influence adverse outcomes in the Dutch situation?
• C. Can regional differences in adverse outcomes be explained by access and use of healthcare?
• D. Is it possible to visualize regional differences in access and use of care with ArcGIS for healthcare providers?

 

Main research activities

• Literature research (supplementing the information that has been found during the Electives and perform additional research when it is required in the Scientific Research Project)
• Working with ArcGIS Desktop (calculating travel time and travel distance with the Drive Time Matrix and visualize outcomes of research questions, (some of) the visualizations will be used in the yearbook of the PRN registry)
• Working with SAS (performing statistical data analysis)
• Communication with healthcare providers
• Project planning
• Scientific writing

 

Methods

The linked PRN data on singleton births will be used for calculation of travel time and travel distance; the calculations will be accomplished by using the Drive Time Matrix. The results of the calculations and the linked PRN data will be used in the logistic regression analysis. In the logistic regression analysis adjustments will be made for other risk factors. In order to create a geographical representation of (regional) differences ArcGIS Desktop will be used.

 

Results

A scientific research paper.

 

Time frame

This scientific research project will be executed in eight months; starting in November 2008 and the project will end in August 2009. During this period several holidays have been planned; Christmas Holidays (20-12-2008 - 04-01-2009), Good Friday (10-04-2009), Easter (13-04-2009), Queen's Day (30-04-2009), Liberation Day (05-05-2009), Ascension Day (21-05-2009) and Whitsun (01-06-2009). The scientific research project consists of 32 weeks, each of 36 hours, in total.

 

References

• 1. Drife JO, Künzel W, Ulmsten U et al. The Peristat Project. European Journal of Obstetrics, Gynecology and Reproductive Biology 2003;111 Supplement 1:S1-S78.
• 2. Tromp M, Eskes M, Reitsma HB et al. Distinct regional differences in perinatal mortality in the Netherlands. Ahead of print.
• 3. Alston M, Allan J, Dietsch E et al. Brutal Neglect: Australian Rural Women's Access to Health Services. Rural and Remote Health 2006;6:475-493.
• 4. Proctor SR and Smith IJ. A Reconsideration of the Factors affecting Birth Outcome in Pakistani Muslim Families in Britain. Midwifery 1992;8:76-81.
• 5. Van der Hulst LAM, van Teijlingen ER, Bonsel GJ et al. Does a Pregnant Woman's intended Place of Birth Influence Her Attitudes toward and Occurrence of Obstetric Interventions. Birth 2004;31:28-33.
• 6. Kleiverda G, Steen AM, Andersen I et al. Place of Delivery in the Netherlands: Maternal Motives and Background Variables related to Preferences for Home or Hospital Confinement. European Journal of Obstetrics & Gynecology and Reproductive Biology 1990;36:1-9.
• 7. Borquez HA and Wiegers TA. A Comparison of Labor and Birth Experiences of Women delivering in a Birthing Centre and at Home in the Netherlands. Midwifery 2006;22:339-347.
• 8. Website of PRN. Last visited at October 15, 2008.
• 9. Website of ArcGIS Desktop. Link to the website. Last visited at October 10, 2008.
• 10. Higgs G. A literature review of the use of GIS-based measures of access to healthcare services. Health Services & Outcomes Research Methodology 2004;5:119-139.
• 11. Graves BA. Integrative literature review: a review of literature related to geographical information systems, healthcare access and health outcomes. Perspectives in Health Information Management 2008;5:11-23.
• 12. O'Sullivan D, Morrison A and John Shearer. Using desktop GIS for the investigation of accessibility by public transport: an isochrones approach. International Journal of Geographical Information Science 2000;14:85-104.

 

Project Administration

Contact

• Mentor: Ms. Dr. A. C. J. Ravelli, AMC Department Medical Informatics, J1B-115-1, 020 - 5664624
• Tutor: Dr. K.J. Jager, AMC Department Medical Informatics, J1B-115-1
• Student: M.H. de Groot
• Advisor: Dr. J.J.H.M. Erwich, UMCG Department Obstetrics & Gynaecology
• Advisor: Prof. B.W.J. Mol, AMC DIVE Obstetrics & Gynaecology
• Advisor: Drs. M. Tromp, AMC Department Medical Informatics, J1B-115-2
• Advisor: M. Eskes, AMC Department Medical Informatics, J1B-121

 

Signatures

• Mentor: Ms. Dr. A. C. J. Ravelli, approved at October 17, 2008
• Tutor: Dr. K.J. Jager, approved at October 17, 2008
• Student: M.H. de Groot, approved at October 17, 2008
• Prof. Dr. Ir. A. Hasman, approved at October 20, 2008