These key performance indicator (KPI) technical definitions support the Implementation guidance: Perinatal Pelvic Health Services.
1. Locally collected KPIs
Outcome statement: All women receive routine antenatal and postnatal information on pelvic health problems, can identify problems and seek treatment.
1: Is coproduced information and education for service users in place across all linked providers?
Definition: Percentage of providers that are routinely providing standardised, co-produced information to service users antenatally about the importance of pelvic health; risks of problems; preventative actions that can be taken to maintain pelvic health; and how to identify issues and seek treatment.
RAG Rating criteria:
- Green: co-produced information is in place in 100% of providers
- Amber: co-produced information is in place in 50% or more providers
- Red: co-produced information is in place in less than 50% of providers
Coproduced information is defined as information that has been developed jointly by staff and service users (perhaps via a local MNVP or similar), working together to ensure that that information and materials about pelvic health is grounded in the lived experience of those with or who have previously experienced pelvic health problems; and to ensure that the information provided reflects what service users believe is helpful as well as important clinical information.
Data Source: Self-reported by Trusts
Numerator: Number of providers that are: routinely providing standardised, co-produced information to service users antenatally about the importance of pelvic health; risks of problems; preventative actions that can be taken to maintain pelvic health; and how to identify issues and seek treatment.
Denominator: Total number of providers
Calculation: Numerator / Denominator x100 (Reported as a percentage)
Frequency: Quarterly
Requirement on Provider:
- To identify and report whether or not information about health problems (as defined) is available locally
- To identify and report whether the available information has been coproduced with service users (for example via a local MNVP)
- To identify and report whether the available information is being supplied to service users antenatally
2: The proportion of service users who are confident in their knowledge of key perinatal pelvic health symptoms and where to find advice/support antenatally
Relevant survey questions:
During your pregnancy, how confident were you that you knew the key symptoms of pelvic health problems?
- Very confident
- Fairly confident
- A little confident
- Not confident
- Don’t know
When you were pregnant, did you know where you could get advice and support for pelvic health problems if needed?
- Yes
- No
- Don’t know
Definition: Percentage of service users who responded ‘Very confident’ or ‘Fairly confident’ to ‘During your pregnancy, were you confident that you knew the key symptoms of pelvic health problems?’ and who also responded ‘Yes’ to ‘Did you know where you could get advice and support with pelvic health problems when you were pregnant if needed?’
Data Source: Survey of women using maternity services. Samples should be random, ensuring responses from at least 5% of service users who have given birth per quarter in your LMNS.
Numerator: Number of service users who responded ‘Very confident’ or ‘Fairly confident’ to ‘During your pregnancy, were you confident that you knew the key symptoms of pelvic health problems?’ and who also responded ‘Yes’ to ‘Did you know where you could get advice and support with pelvic health problems when you were pregnant if needed?’
Denominator: Total number of respondents who provided a valid response to both questions, excluding respondents who responded ‘Don’t know’ to either question.
Calculation: Numerator / Denominator x100 (Reported as a percentage)
Frequency: Quarterly
Requirement on provider: To co-produce survey, provide it to service users, gather responses, store and analyse data (ensuring compliance with Trust/provider information governance).
Outcome statement: All women report their initial baseline situation as early as possible in pregnancy – by 18 weeks – and by/at the postnatal GP check using a validated self-assessment tool.
3: The proportion of service users completing baseline self-assessment by 18 weeks gestation
Metric to be defined when national Self-Assessment Tool is published.
Data source: Self-Assessment Tool
4: The proportion of service users completing baseline self-assessment at six to eight weeks postnatally
Metric to be defined when national Self-Assessment Tool is published.
Data source: Self-Assessment Tool
Outcome statement: All service users receive information and support on how to do PFE as early in pregnancy as possible and as part of routine antenatal and postnatal care.
5: The proportion of service users who are confident to begin and maintain pelvic floor exercises (of those service users offered information about things they could do while pregnant to reduce the risk of pelvic health problems, such as pelvic floor exercises)
Relevant survey questions:
Were you offered information about things you could do while you were pregnant to reduce the risk of pelvic health problems (such as pelvic floor exercises)?
- Yes
- No
- Don’t know
Based on the information you were given by your NHS maternity team when you were pregnant, how confident were you performing pelvic floor exercises?
- Very confident
- Fairly confident
- A little confident
- Not confident
- I was not able to do pelvic floor exercises
- I chose not to do pelvic floor exercises
Definition: Proportion of service users who responded ‘Yes’ to ‘Were you offered information about things you could do while you were pregnant to reduce the risk of pelvic health problems (such as pelvic floor exercises)?’ and ‘Very Confident’ or ‘Fairly Confident’ to ‘Based on the information you were given by your NHS maternity team when you were pregnant, how confident were you performing pelvic floor exercises?’
Data Source: Survey of women using maternity services. Samples should be random, ensuring responses from at least 5% of service users who have given birth per quarter in your LMNS.
Numerator: Number of service users who responded ‘Yes’ to ‘Were you offered information about things you could do while you were pregnant to reduce the risk of pelvic health problems (such as pelvic floor exercises)?’ and ‘Very Confident’ or ‘Fairly Confident’ to ‘Based on the information you were given by your NHS maternity team when you were pregnant, how confident were you performing pelvic floor exercises?’
Denominator: Total number of service users who responded ‘Yes’ to ‘Were you offered information about things you could do while you were pregnant to reduce the risk of pelvic health problems (such as pelvic floor exercises)?’ and then provided a valid response to ‘Based on the information you were given by your NHS maternity team when you were pregnant, how confident were you performing pelvic floor exercises?’
Calculation: Numerator / Denominator x100 (Reported as a percentage)
Frequency: Quarterly
Requirement on provider: To co-produce survey, provide it to service users, gather responses, store and analyse data (ensuring compliance with Trust/provider information governance).
Outcome statement: All staff providing care and support to women (including those working in maternity and gynaecology services, primary care and health visitors) are competent and confident in the identification and, where appropriate, management or referral pathways for pelvic health problems; accessing regular training as required to maintain their skills.
6: The proportion of service users who report being routinely asked about pelvic health in postnatal care
Relevant survey questions:
Were you asked whether you had any problems with your pelvic health during scheduled appointments after birth?
- At every appointment
- At some appointments
- Never
- Don’t know
Definition: Proportion of service user who responded ‘At every appointment’ to ‘Were you asked whether you had any problems with your pelvic health at scheduled appointments after the birth?’
Data Source: Survey of women using maternity services. Samples should be random. A response rate of at least 5% of service users who have given birth per quarter in your LMNS is recommended for representation.
Numerator: Number of service users who responded ‘At every appointment’ to ‘Were you asked whether you had any problems with your pelvic health at scheduled appointments after the birth?’
Denominator: Total number of service users who provided a valid response to the question, excluding respondents who responded ‘Don’t know’.
Calculation: Numerator / Denominator x100 (Reported as a percentage)
Frequency: Quarterly
Requirement on Provider: To co-produce survey, provide it to service users, gather responses, store and analyse data (ensuring compliance with Trust/provider information governance).
Outcome statement: Services grow their capacity to meet demand, by increasing their establishment of Specialist Physiotherapists and other relevant staff within PPHS.
7: Whole time equivalency (WTE) and banding of specialist physiotherapists with time dedicated to PPHS
Definition: Systems should provide numbers of whole-time equivalents and total numbers of staff per banding. Only Physiotherapists with time dedicated to PPHS should be included. This is defined as physiotherapists who have specific time allocated to pelvic health within their job plans (and so this allocated time is formally documented). Please do not include details of physiotherapists providing support, which is not specifically related to pelvic health, and for which allocated time is not documented within their job plans. Information should be provided at both individual provider level and aggregated at system level.
Data Source: Reported by Trusts from their electronic staff record systems (e.g., ESR)
Numerator: WTE and banding of physiotherapists with time dedicated to PPHS
Frequency: Quarterly
Requirement on Provider: To extract and provide details from the electronic staff record, in tabular form, of the WTE and headcount of physio staff with time allocated in their job plans to provide services and support within the PPHS.
Outcome statement: All women, for whom it is appropriate, can be referred to specialist, personalised care in a timely manner (either via a clinician referral or via self-referral). A single point of access and clear and streamlined referral pathways are in place for all women antenatally and for at least 12 months postnatally.
8: Is a Single Point of Access in place for all service users with perinatal pelvic health problems across all linked providers?
Definition: Proportion of providers with a Single Point of Access or Standardised Points of Access in place. For the purposes of PPHS, and this KPI, a single point of access (SPoA) is defined as
The provision of a single point of contact into which all referrals for PPHS and support for a defined provider or system are sent (i.e., all referrals – whether from a clinician or self-referrals if available – are funnelled through this SPoA and it is marketed locally as the single point of access for service users with pelvic health problems) with a multidisciplinary team which is able to effectively triage received referrals, assess risk and priority, and refer the patient into the most appropriate pathway of care to meet their needs.
Where one single point of access is not feasible across the LMNS footprint (for example, due to a lack of digital interoperability), standardised points of access can be established across the footprint. In this case, every point of access must work to shared standard operating procedures (SOPs), with individual monitoring/review to ensure equal service provision and standards across the System. The number of standardised points of access should be kept to a minimum to reduce complexity and decision making for signposting professionals and women.
RAG Rating criteria.
- Green: A single point of access/standardised points of access are in place for all service users with perinatal health problems in 100% of providers.
- Amber: A single point of access/standardised points of access are in place for all service users with perinatal pelvic health problems in 50% or more of providers (i.e., a SPoA may be in place but does not cover all providers across the local system)
- Red: A single point of access/standardised points of access for all service users with perinatal pelvic health problems is in place in less than 50% of providers (or not at all)
Data Source: Self-reported by Trusts
Numerator: Number of Providers within the System where an SPoA is in place for all service users with perinatal pelvic health problems
Denominator: Total number of maternity providers within the System
Calculation: Numerator / Denominator x 100 gives the percentage for RAG Rating. To report the RAG rate as per the criteria outlined in the definition.
Frequency: Quarterly
Requirement on Provider: To confirm and report whether or not a Single Point of Access (SPoA) is in place across the local LMNS system using the agreed RAG ratings.
9: Rate of referrals to service (clinician or self-referral)
Definition: Rate of referrals to the PPHS via the SPoA. Referrals are defined as a request for a first or new spell episode of specialist care for a patient, to be delivered by the PPHS. The request has come into the Single Point of access (see definition above) from either a clinician post patient contact, or via a patient-initiated request.
Data source: Reported by Trusts from Patient Administration System
Numerator: Number of referrals to SPoA by referral type (a) clinician referral and (b) self-referral
Denominator: Number of births across system
Calculation: Numerator / Denominator x100 (Reported as a percentage)
Frequency: Quarterly
Requirement on provider: To track referrals to SPoA and calculate metric accordingly
11: The proportion of service users who are satisfied with how quickly they can receive specialist care from a pelvic health physiotherapist when needed
Relevant survey question:
Once you knew you needed to see a pelvic health physiotherapist, how satisfied were you with the time it took to see one?
- Very satisfied
- Fairly satisfied
- Neither satisfied nor dissatisfied
- Not very satisfied
- Not at all satisfied
Definition: The proportion of service users who responded ‘Very satisfied’ or ‘Fairly satisfied’ to ‘Once you were told that you needed to see a pelvic health physiotherapist, how do you feel about the time it took to see one?’
Data Source: Survey given to all women who have received care from the PPHS.
Numerator: Number of service users who responded ‘Very satisfied’ or ‘Fairly satisfied’ to ‘Once you were told that you needed to see a pelvic health physiotherapist, how do you feel about the time it took to see one?’
Denominator: Number of service users who provide a valid response to ‘Once you were told that you needed to see a pelvic health physiotherapist, how do you feel about the time it took to see one?’
Calculation: Numerator / Denominator x100 (Reported as a percentage)
Frequency: Quarterly
Requirement on provider: To co-produce survey, provide it to service users, gather responses, store and analyse data (ensuring compliance with Trust/provider information governance).
12: Numbers waiting for referral to treatment (RTT) in time bands from referral to first physiotherapy appointment
Data Source: Reported by Trusts from Patient Administration System
Numerator: The number of ended referrals that finish a course of treatment in the reporting period who received their first treatment appointment within 2 weeks (urgent) or 12 weeks (routine) of referral
Denominator: The number of ended referrals who finish a course of treatment in the reporting period
Calculation: Numerator / Denominator x100 (Reported as a percentage)
Frequency: Quarterly
Requirement on provider: To track and record clock starts and clock stops according to RTT rules.
Outcome statement: Women experience improved pelvic health at defined points antenatally and postnatally, following treatment and intervention from PPHS.
13: The proportion of service users reporting improvements on patient functional rating scales
Metric to be defined when national Self-Assessment Tool is published.
Data source: Self-Assessment Tool
Outcome statement: Women are satisfied with the quality of specialist care and support when needed.
14: The proportion of service users satisfied with the quality of specialist care and support when needed
Relevant survey question:
Overall, how satisfied are you with the quality of the care and support you received in relation to your pelvic health problem?
- Very satisfied
- Fairly satisfied
- Neither satisfied nor dissatisfied
- Not very satisfied
- Not at all satisfied
Definition: The proportion of service users who responded ‘Very satisfied’ or ‘Fairly satisfied’ to ‘Overall, how do you feel about the quality of the care and support you received in relation to pelvic health problem?’
Data source: Survey given to all women who have received care from the PPHS.
Numerator: Number of service users who respond ‘Very satisfied’ or ‘Fairly satisfied’ to ‘Overall, how do you feel about the quality of the care and support you received in relation to pelvic health problem?’
Denominator: Number of service users who provide a valid response to the question.
Calculation: Numerator / Denominator x100 (reported as a percentage)
Frequency: Quarterly
Requirement on Provider: To co-produce survey, provide it to service users, gather responses, store and analyse data (ensuring compliance with Trust/provider information governance)
2. Nationally Collected KPIs
Outcome statement: All staff providing care and support to women (including those working in maternity and gynaecology services; GPs and health visitors) are competent and confident in the identification and, where appropriate, management or referral pathways for pelvic health problems; accessing regular training as required to maintain their skills.
15: The proportion of service users who felt that the GP definitely spent enough time talking to them about their own physical health at the six to eight week postnatal check-up.
Definition: The proportion of service users who responded ‘Yes, definitely’, to Question F20: Did GP spend time talking to you about physical health? of the Care Quality Commission (CQC) Maternity Services Survey. Please note that question numbers can change between survey years.
Numerator: Total number service users who responded ‘Yes, definitely’, to Question F20: Did GP spend time talking to you about physical health? of the CQC Maternity Services Survey.
Denominator: Total number of service users who provided a valid response to question F20: Did GP spend time talking to you about physical health? of the CQC Maternity Services Survey, excluding service users who responded ‘Don’t know/Can’t remember’.
Calculation: Numerator / Denominator x100 (Reported as a percentage)
Frequency: Annually
Requirement on Provider: None
Outcome statement: Fewer women experience perineal tears; in particular, fewer OASI (third- and fourth-degree tears).
16: Percentage of third- and fourth-degree tears
Definition:
- Third-degree tear: Injury to perineum involving the anal sphincter complex:
- Grade 3a tear: Less than 50% of external anal sphincter (EAS) thickness torn.
- Grade 3b tear: More than 50% of EAS thickness torn.
- Grade 3c tear: Both EAS and internal anal sphincter (IAS) torn.
- Fourth-degree tear: Injury to perineum involving the anal sphincter complex (EAS and IAS) and anorectal mucosa.[1]
Data source: Secondary Uses Service (SUS) Admitted Patient Care Minimum Dataset
Numerator: Number of service users with third- or fourth-degree tear (measured with ICD-10 codes O70.2; O70.3)
(Where possible, numerator and denominator would helpfully be separated by assisted and non-assisted birth).
Denominator: Total vaginal births (Where possible, numerator and denominator would helpfully be separated by assisted and non-assisted birth).
Calculation: Numerator / Denominator x 100 (Reported as a percentage)
Frequency: Quarterly (whole quarter)
[1] RCOG