Case study 3: Maternal newborn metrics

Next, a rapid review related to improving the health of pregnant women and newborn babies.

Question: What steps can hospitals take to improve health outcomes for pregnant women and newborn babies?

The Better Outcomes Registry & Network (BORN) observed wide variation in maternal-newborn care across hospitals in Ontario, Canada and sought to implement an ‘audit and feedback’ dashboard intervention to drive behavior change among clinicians.

But, before it could create the program, BORN investigators needed more information about the effectiveness and safety of a range of practices for newborns. The Knowledge to Action research program was commissioned to produce rapid reviews to provide evidence on the 6 maternal newborn care practices for the BORN dashboard (e.g., timing of elective repeat caesarean, factors associated with in-hospital formula supplementation).

Approach taken

The rapid reviews were completed in about 6-8 weeks and the shortcuts varied with the type of question, the availability of evidence, and the needs of different stakeholders for each indicator. In general, the evidence was quite large and stakeholders were interested in a range of questions. 

To accommodate the needs of the stakeholders, the rapid reviews tended to prioritize evidence from recent systematic reviews. They then combined that evidence with information from grey literature (e.g., relevant white papers from obstetrical guideline bodies). In terms of review processes, data extraction, quality assessment, and narrative synthesis were done by one reviewer. 


Evidence from these rapid reviews was used to create a “Maternal dashboard” with six new indicators of clinical care for pregnant woman and newborns. According to an evaluation conducted in Ontario between 2009 and 2013, the indicators led to significant improvements in care for mothers and their newborns.