In recent times the options available to women for antenatal care and birth have expanded. This includes the provision of more midwifery-led care models. This diversification creates a need for common terminology in describing and comparing these models and the outcomes for women and their babies. Hence, the Maternity Care Classification System (MaCCS) was developed to classify, record and report data about maternity models of care in Australia.
The MaCCS will produce a data set for reporting on models of care available in each jurisdiction and nationally. As well, the future inclusion of two new data items in the National Perinatal Data Collection to record the model of care for each woman will enable future reporting on outcomes for mothers and babies under different models or by different model characteristics.
The MaCCS was developed as part of the National Maternity Data Development Project (NMDDP), which included a component to design a nomenclature for maternity models of care in Australia. A Maternity Model of Care Data Set Specification (MoC DSS) was then developed to underpin the MaCCS. This DSS contains data elements that capture the characteristics of models, including a Major Model Category (MMC) and a unique model ID. To ensure the data standards were comprehensive and exhaustive, a national pilot of the MoC DSS was conducted. This report provides an account of the pilot process and results.
The pilot was conducted over June to September 2014 in a representative mix of birthing sites. It was specifically designed to test the technical aspects of the data elements rather than to test the complete MaCCS as a classification system. The pilot aimed to ensure a number of things: that permissible responses in the data elements were correct and complete, that there were comprehensive instructions for users, that values for the 10 MMCs were correct and exhaustive and that all models could be assigned to a single MMC.
A total of 46 sites across each jurisdiction in Australia participated, and surveys for 217 maternity models of care were received and analysed. The pilot proved invaluable for refining the DSS. Outcomes included:
- confirmation that the 10 MMCs included in the MaCCS are suitable for classifying all models of care currently in use in Australia, except for 1 emerging model for private obstetrician/private midwife care that will be added to the list of MMCs
- demonstration that the use of data standards alone is not enough to ensure high-quality data collection, particularly when novel concepts are being introduced
- confirmation of the need for a purpose-built electronic data collection tool to improve the accuracy of data collected-and a comprehensive education program to support it.
As a result of the pilot, there were over 50 detailed recommendations made including:
- replacing several data elements in the MoC DSS to address major data quality issues and modifying others, with additional instructions in the user guide
- identifying numerous decision-rules/validation checks for incorporation in the specifications for a future electronic MaCCS data collection tool
- defining the areas of focus for any education and training package that is developed. When this report was published, the MoC DSS had been endorsed as a new national data standard, and work is now underway to develop the MaCCS data collection tool.