VBHC in pregnancy and childbirth

This initiative focuses on one medical condition: pregnancy and childbirth. As a pilot we plan to examine patient value for neonatal streptococcal infection that manifests shortly after birth. We aim to decrease neonatal death and morbidity and increase patient’s birth experience while at the same time decreasing health care costs.

Neonatal streptococcal infection manifests shortly after vaginal birth in women who carry this vaginal bacteria. Intravenous antibiotics during birth is key in decreasing incidence of neonatal infection, sepsis and death. Currently patients who are infected by this bacteria are transferred from a primary care setting at 36 weeks of pregnancy to a hospital setting (for follow-up and birth), as intravenous antibiotic administration is currently a clinical intervention.

New Dutch guidelines (2017) recommend a stricter policy concerning screening and treatment of infection carrying pregnant women. In effect, this will potentially decrease neonatal death and morbidity. At the same time this protocol will lead to more hospital births (and more health care costs) and potentially a decrease in birth experience outcomes(as more women switch to hospital accompanied births instead of their primary care midwife).

By substitution from hospital to primary care this pilot aims to create the same improvement in neonatal outcomes (mortality and morbidity decrease) and simultaneously increase birth experience and decrease costs.
In our region (Zwolle) of around 4500 births per year, around 100-400 patients are known to carry this infection. Clinical (second line, hospital accompanied) follow-up and births are costly compared to primary care. For 100 patients we calculated health care savings for at least €200.000,- a year and could potentially be a 4-fold saving.

All pregnant women will be included in the screening programme in primary and hospital care. An interdisciplinary team consisting of gynecologists, pediatricians, neonatologists, primary care midwives, hospital-based midwives, O&G residents, maternity care staff, lactation experts, hospital management and support staff is involved in the initiative.
This pilot is implementable for many other transmural subtopics within pregnancy and it therefore has potential for upscaling in the near future. It also opens up the discussion on falling behind in quality of obstetric care compared to neighbouring countries and is therefore a great model for collaboration between all obstetric care providers to greatly increase patient value.