Evidence map›Paper›PMID 40420048›Full record

Observational studyBMC pregnancy and childbirth2025

Value-based evaluation of gestational diabetes mellitus care pathway redesign by using cost and outcome data.

Maud van den Berg, Julia Spaan, Jacoba van der Kooy, Monique Klerkx, Charlotte Krol, Arie Franx, Kees T B Ahaus, Hilco J van Elten

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMC pregnancy and childbirth, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Maud van den BergErasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, 3062 PA, The Netherlands. vandenberg@eshpm.eur.nl.ORCID http://orcid.org/0000-0002-7462-1470
Julia SpaanObstetrics and Gynaecology, Amphia Hospital, Molengracht 21, Breda, 4818 CK, The Netherlands.
Jacoba van der KooyDepartment of Obstetrics and Gynaecology, Erasmus Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands.
Monique KlerkxMidwifery Practice, Verloskundigen Oosterhout, Sint Antoniusstraat 86a, Oosterhout, 4902 PV, The Netherlands.
Charlotte KrolInternal Medicine, Amphia Hospital, Molengracht 21, Breda, 4818 CK, The Netherlands.
Arie FranxDepartment of Obstetrics and Gynaecology, Erasmus Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands.
Kees T B AhausErasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, 3062 PA, The Netherlands.
Hilco J van EltenDepartment of Accounting, Vrije Universiteit Amsterdam, De Boelelaan 1105, Amsterdam, 1081 HV, The Netherlands.

Funding

ZonMw 516008006
6 · The paper itself

Abstract

backgroundGestational diabetes mellitus (GDM) is a common complication of pregnancy. Implementation of Value-Based Healthcare (VBHC) to GDM care is worthwhile as traditional GDM care is fragmented and fails to meet the needs of women with GDM. Value of care can be improved through optimization and redesign of the care pathway and implementation of an outcome-based payment model. This study was conducted to perform a value-based evaluation of GDM care pathway redesign by using cost- and outcome data.

methodsThis study was designed as a single center, prospective, observational cohort study. In January 2022, GDM care was redesigned by substituting GDM care activities from an Internal Medicine Department (IMD) to an Integrated Maternity Care Organization (IMCO) in the Netherlands. Women diagnosed with GDM in 2021 were assigned to a pre-intervention cohort (N = 264) and those diagnosed in 2022 to a post-intervention cohort (N = 407). The impact of the intervention on value of care for women with GDM was evaluated by comparing clinical outcomes, patient-reported experience measures (GDM Responsiveness questionnaire), and costs (Time-Driven Activity-Based Costing) between the cohorts.

resultsReferrals to the IMD for GDM decreased by 84.8% (pre-intervention: 100%, post-intervention: 15.2%, p <.001), patient-reported experiences significantly improved (Mean responsiveness pre-intervention: 3.46, post-intervention: 3.63, p: 0.00). Initiation of insulin treatment decreased by 46.8% (pre-intervention: 25.0%, post-intervention: 13.3%, p <.001). Maternal- and neonatal clinical outcomes were not different after redesign. Weighted average costs per GDM treatment were 9.7% lower post-intervention (pre-intervention: €168,37, post-intervention: €151,97).

conclusionsThe redesign of GDM care positively impacted value through decreased referrals and improved patient-reported experiences while clinical outcomes remained constant. By de-fragmenting GDM care, cost savings were realized. This study contributes to the improvement of care delivery, particularly in pregnancy and childbirth, by promoting the adoption of comprehensive, value-based evaluations of redesign initiatives and supports the further uptake of VBHC in maternity care.

Indexed as

Critical PathwaysDiabetes, GestationalHealth Care CostsAdultCost-Benefit AnalysisFemaleHumansNetherlandsPregnancyProspective StudiesClinical outcomesGestational diabetes mellitusPatient-reported experience measuresService delivery redesignTime-driven activity-based costingValue-based healthcare

Identifiers

PMID40420048
PMCPMC12105306

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.