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. Proposed Evaluation Questions Overview Literature OMP Program Overview

4. Proposed Evaluation Questions Overview Literature History Midwifery became regulated in Ontario in 1994 n 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

5. Proposed Evaluation Questions Overview Literature Midwifery Service Components Midwifery Education Midwifery Practice Midwifery Research n The current study is limited in scope to midwifery practice only

6. Proposed Evaluation Questions Overview Literature Program Components Education/Prevention Pre-natal care Labour/Birth care Post-partum care Counseling/Support

7. Proposed Evaluation Questions Overview Literature

8. Proposed Evaluation Questions Overview Literature What the Literature Shows

9. Proposed Evaluation Questions Overview Literature In General No studies found evaluating funding formula/method/process Some cost-effectiveness studies n Focused more on outcomes however n Showed some improved outcomes for midwifery over obstetrics

10. Proposed Evaluation Questions Overview Literature Quebec Pilot Multi-faceted evaluation Set up for failure, but also for success Lots of opposition to midwifery services in Quebec n Midwifery regulation was adopted in the end however Outcome measures showed positive improvements over obstetric care

11. Proposed Evaluation Questions Overview Literature Description of Evaluation Proposal

12. Proposed Evaluation Questions Overview Literature Two Parts Process Evaluation: n Funding methods and effectiveness Outcome Evaluation: n Economic cost-effectiveness analysis

13. Proposed Evaluation Questions Overview Literature Design 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

14. Proposed Evaluation Questions Overview Literature Outcome Measures 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

15. Proposed Evaluation Questions Overview Literature Limitations 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.

16. Proposed Evaluation Questions Overview Literature Questions?