{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T22:35:10Z","timestamp":1764714910000},"reference-count":29,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2019,3,1]],"date-time":"2019-03-01T00:00:00Z","timestamp":1551398400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Dutch Organisation for Health Research and Development","award":["209020001"],"award-info":[{"award-number":["209020001"]}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To study the effect of an intervention based on Crew Resource Management team training, including a tool for structured communication, on adverse perinatal and maternal outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Stepped wedge.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>The Netherlands.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population or sample<\/jats:title><jats:p>Registry data of 8123 women referred from primary care to a hospital during childbirth, at \u2265 32.0 weeks of singleton gestation and with no congenital abnormalities, in the period 2012\u201315.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Obstetric teams of five hospitals and their surrounding primary\u2010care midwifery practices participated in the intervention. In total, 49 team training sessions were organised for 465 care professionals (75.5% participated). Adverse perinatal and maternal outcomes before, during and after the intervention were analysed using multivariate logistic regression analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>Adverse Outcome Index (<jats:styled-content style=\"fixed-case\">AOI<\/jats:styled-content>\u20105), a composite measure involving; intrapartum or neonatal death, admission to neonatal intensive care unit, <jats:styled-content style=\"fixed-case\">Apgar<\/jats:styled-content> &lt; 7 at 5 minutes, postpartum haemorrhage and\/or perineal tear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, an <jats:styled-content style=\"fixed-case\">AOI<\/jats:styled-content>\u20105 score was reported in 11.3% of the study population. No significant difference was found in the incidence of the <jats:styled-content style=\"fixed-case\">AOI<\/jats:styled-content>\u20105 score after the intervention compared with before the intervention (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.07: 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.92\u20131.24).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We found no effect of the intervention on adverse perinatal and maternal outcomes for women who were referred during childbirth. Team training is appreciated in practice, but evidence on the long\u2010term impact is still limited. Upcoming studies should build on previous research and consider more sensitive outcome measures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>A cluster randomised team training intervention showed no effect on adverse perinatal and maternal outcomes for women referred during childbirth.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.15611","type":"journal-article","created":{"date-parts":[[2019,1,11]],"date-time":"2019-01-11T16:16:21Z","timestamp":1547223381000},"page":"907-914","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Effect of a cluster randomised team training intervention on adverse perinatal and maternal outcomes: a stepped wedge study"],"prefix":"10.1111","volume":"126","author":[{"given":"A","family":"Romijn","sequence":"first","affiliation":[{"name":"Department of Public and Occupational Health Amsterdam Public Health Research Institute Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ACJ","family":"Ravelli","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology and Department of Medical Informatics Amsterdam UMC University of Amsterdam Amsterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"MC","family":"de Bruijne","sequence":"additional","affiliation":[{"name":"Department of Public and Occupational Health Amsterdam Public Health Research Institute Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"JWR","family":"Twisk","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C","family":"Wagner","sequence":"additional","affiliation":[{"name":"Department of Public and Occupational Health Amsterdam Public Health Research Institute Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam the Netherlands"},{"name":"NIVEL Netherlands Institute for Health Services Research Utrecht the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"CJM","family":"de Groot","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"PW","family":"Teunissen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam the Netherlands"},{"name":"School of Health Professions Education (SHE) Maastricht University Maastricht the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,3]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/qshc.2004.010033"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-6576.2008.01717.x"},{"key":"e_1_2_6_4_1","unstructured":"The Joint Commission. 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