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Does the Dashboard Make a Difference?

The Dashboard is an online tool to support uptake of evidence-based clinical practices on a large scale; near real-time information about clinical practice and outcomes is provided to all maternal-newborn hospitals in Ontario on an ongoing basis. But does the Dashboard actually make a difference in the care provided?

 

Considerable differences in maternal-newborn care practices and patient outcomes are evident across Ontario, suggesting room for improvement. To address this issue, BORN Ontario implemented a unique alert system, called the Maternal Newborn Dashboard in November 2012. The Dashboard is an online tool to support uptake of evidence-based clinical practices on a large scale; near real-time information about clinical practice and outcomes is provided to all maternal-newborn hospitals in Ontario on an ongoing basis.

But does the Dashboard actually make a difference in the care provided? A recent study[1] looked at the effect of the Dashboard on six indicators of clinical practice. Researchers compared 3 years of data collected prior to Dashboard implementation with 2.5 years of data collected after implementation. The six clinical performance indicators studied were:

  1. Rate of newborn screening samples received by Newborn Screening Ontario that are unsatisfactory for testing
  2. Rate of episiotomy in women who had a spontaneous vaginal birth
  3. Rate of formula supplementation in women who reported intending to exclusively breastfeed
  4. Rate of repeat caesarean deliveries in low risk women not in labour occurring before 39 weeks
  5. Rate of  Group B Streptococcus (GBS) screening at 35-37 weeks gestational age
  6. Rate of inductions for post-dates in women who delivered before 41 weeks

Researchers found that the implementation of the Dashboard was associated with improvements in 4 of these indicators. Effects of the Dashboard 2.5 years after implementation were as follows:

  • A reduction of 1.5 episiotomies per hundred women
  • A reduction of 10.4 elective repeat caesarean deliveries prior to 39 weeks per hundred women
  • A reduction of 11.7 inductions done for post-dates in women who were not post-dates at delivery, per hundred women.

Researchers also found an increase of 2.8 per hundred in the number of women receiving GBS screening. The Dashboard did not have an effect on formula supplementation or unsatisfactory screens.  

So why does all of this matter? Almost 140,000 babies are born each year in Ontario; each baby represents an opportunity for providing quality care. Thanks to this innovative online alert system all maternal-newborn care centers in the province can see when evidence-based care is not occurring and take steps to change this.

[1] Weiss D, Dunn SI, Sprague AE, BMJ Qual Saf Published Online First 2017 doi:10.1136/bmjqs-2017-007361