Grant: Health System Impact Fellowships - PostDoc Central Canada 2 year

Prenatal screening is offered to all pregnant women to determine if a pregnancy is at risk for specific health problems. To maintain a high quality program that is up to date with new technology, health care providers, laboratories and policymakers must work collaboratively. Prenatal Screening Ontario (PSO) is responsible for overseeing and coordinating health care providers (e.g. sonographers, physicians, midwives, radiologists, genetic counsellors etc.) laboratories, and policymakers, in an effort to ensure care is of high-quality and accessible to all women across the province. This is a challenging task because the relationships among the stakeholders are complex, and decision-making authority is not always clear. Motivated by this challenge, the proposed project seeks to understand how program organization impacts quality of care, within the context of a population screening system. Through fieldwork and a range of qualitative data collection strategies, this project will explore and define the specific quality challenges Ontario is facing (e.g. inaccurate tests, inappropriate spending/testing, poor access to care). This work involves describing where and how various stakeholders are interacting, and whether and how that impacts quality. Building from the Ontario case, a scoping review will identify approaches to ensuring prenatal screening quality in other jurisdictions and settings. Three cases will be selected for comparison to Ontario. The purpose of this research is to identify barriers and facilitators to achieving a high-quality prenatal screening system. Finally, in consultation with screening system experts, the findings will be developed into a quality improvement framework that PSO can implement and use to enhance care delivery.