Mieke J van Veen1, Erwin Birnie2, Jashvant Poeran3, Hanneke W Torij4, Eric A P Steegers5, Gouke J Bonsel6. 1. Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Rotterdam, The Netherlands. Electronic address: m.j.van.veen@hr.nl. 2. Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, The Netherlands. 3. Weill Cornell Medical College, Department of Public Health, Division of Biostatistics and Epidemiology, New York, USA. 4. Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Rotterdam, The Netherlands. 5. Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, The Netherlands. 6. Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, The Netherlands; Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, The Netherlands.
Abstract
OBJECTIVE: to study in routine care the feasibility and inter-rater reliability of the Rotterdam Reproductive Risk Reduction risk score card (R4U), a new semi-quantitative score card for use during the antenatal booking visit. The R4U covers clinical and non-clinical psychosocial factors and identifies overall high risk pregnancies, qualifying for intensified antenatal care. DESIGN: a population-based cross-sectional study (feasibility) and a cohort study (inter-rater reliability). SETTING: feasibility was studied in six midwifery practices and two hospitals; the reliability study was performed in one midwifery practice. PARTICIPANTS: 1096 pregnant women in the feasibility study and a subsample of 133 participants in the inter-rater reliability study. MEASUREMENTS: feasibility was expressed as (a) time needed to complete the R4U and (b) the missing rate at the item and client level. For inter-rater reliability (IRR) an independent, blinded, caregiver completed a re-test R4U during a second visit; inter-rater agreement for each item and all domain sum scores were computed. FINDINGS: completion of the R4U took 5 minutes or less in 63%; and between 5 and 10 minutes in another 33%. On the participant level 0.2% of women had >20% missing values (below 4% threshold, P<0.001). One of 77 items had a >10% missing rate. The per item IRR was 100% in 20% of the items, and below the predefined 80% threshold in 13% of the items (n=9). The domain sum scores universally differed less than the predetermined ±15% margin. KEY CONCLUSION: the R4U risk score card is a feasible and reliable instrument. IMPLICATION FOR PRACTICE: the R4U is suitable for the assessment of clinical and non-clinical risks during the antenatal booking visit in a heterogeneous urban setting in routine practice.
OBJECTIVE: to study in routine care the feasibility and inter-rater reliability of the Rotterdam Reproductive Risk Reduction risk score card (R4U), a new semi-quantitative score card for use during the antenatal booking visit. The R4U covers clinical and non-clinical psychosocial factors and identifies overall high risk pregnancies, qualifying for intensified antenatal care. DESIGN: a population-based cross-sectional study (feasibility) and a cohort study (inter-rater reliability). SETTING: feasibility was studied in six midwifery practices and two hospitals; the reliability study was performed in one midwifery practice. PARTICIPANTS: 1096 pregnant women in the feasibility study and a subsample of 133 participants in the inter-rater reliability study. MEASUREMENTS: feasibility was expressed as (a) time needed to complete the R4U and (b) the missing rate at the item and client level. For inter-rater reliability (IRR) an independent, blinded, caregiver completed a re-test R4U during a second visit; inter-rater agreement for each item and all domain sum scores were computed. FINDINGS: completion of the R4U took 5 minutes or less in 63%; and between 5 and 10 minutes in another 33%. On the participant level 0.2% of women had >20% missing values (below 4% threshold, P<0.001). One of 77 items had a >10% missing rate. The per item IRR was 100% in 20% of the items, and below the predefined 80% threshold in 13% of the items (n=9). The domain sum scores universally differed less than the predetermined ±15% margin. KEY CONCLUSION: the R4U risk score card is a feasible and reliable instrument. IMPLICATION FOR PRACTICE: the R4U is suitable for the assessment of clinical and non-clinical risks during the antenatal booking visit in a heterogeneous urban setting in routine practice.
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