Midwifery Evaluation

1
The Ontario Midwifery Program
Program Evaluation Proposal
Summer 2002
2

• OMP Program Overview
• What the Literature Shows
• Description of Evaluation Proposal
• Questions (and a Few Answers)

Agenda
3
OMP Program Overview
Overview
Literature
Proposed Evaluation
Questions
4
History
Overview

• Midwifery became regulated in Ontario in 1994
• Midwifery care existed previously but wasnt
  covered by OHIP
• The Ontario Midwifery Program was formed as a
  result
• Other provinces followed suit by regulating
  midwifery services

Literature
Proposed Evaluation
Questions
5
Midwifery Service Components
Overview

• Midwifery Education
• Midwifery Practice
• Midwifery Research
• The current study is limited in scope to
  midwifery practice only

Literature
Proposed Evaluation
Questions
6
Program Components
Overview

• Education/Prevention
• Pre-natal care
• Labour/Birth care
• Post-partum care
• Counseling/Support

Literature
Proposed Evaluation
Questions
7
Overview
Literature
Proposed Evaluation
Questions
8
What the Literature Shows
Overview
Literature
Proposed Evaluation
Questions
9
In General
Overview

• No studies found evaluating funding
  formula/method/process
• Some cost-effectiveness studies
• Focused more on outcomes however
• Showed some improved outcomes for midwifery over
  obstetrics

Literature
Proposed Evaluation
Questions
10
Quebec Pilot
Overview

• Multi-faceted evaluation
• Set up for failure, but also for success
• Lots of opposition to midwifery services in
  Quebec
• Midwifery regulation was adopted in the end
  however
• Outcome measures showed positive improvements
  over obstetric care

Literature
Proposed Evaluation
Questions
11
Description of Evaluation Proposal
Overview
Literature
Proposed Evaluation
Questions
12
Two Parts
Overview

• Process Evaluation
• Funding methods and effectiveness
• Outcome Evaluation
• Economic cost-effectiveness analysis

Literature
Proposed Evaluation
Questions
13
Design
Overview

• Comparative data analysis approach
• Economic cost-effectiveness analysis will also be
  used
• The sample population consists of low-risk
  pregnant women receiving maternity care in 2000,
  2001, and 2002 in Ontario, Canada

Literature
Proposed Evaluation
Questions
14
Outcome Measures
Overview

• Number of prenatal visits per client
• Epidural use during labour
• Use of delivery aid devices
• Caesarean section required
• Episiotomy required
• Resuscitation required
• Length of hospital stay

Literature
Proposed Evaluation
Questions
15
Limitations
Overview

• The client viewpoint is used rather than the
  preferred societal viewpoint.
• The use of TPAs is a recent addition to the OMP
  and therefore data availability may be limited.
• A cost-effectiveness analysis doesnt give as
  complete a picture.
• Comparing obstetric care data to midwifery care
  data may be inherently difficult.

Literature
Proposed Evaluation
Questions
16
Questions?
Overview
Literature
Proposed Evaluation
Questions