Peer Review History

Original SubmissionSeptember 25, 2019
Decision Letter - Adya Misra, Editor

Dear Dr. Yelland,

Thank you very much for submitting your manuscript "‘Bridging the Gap’: Systems reform in Victorian public hospitals to improve access to antenatal care for women of refugee background evaluated using an interrupted time series design" (PMEDICINE-D-19-03494) for consideration at PLOS Medicine.

Your paper was evaluated by a senior editor and discussed among all the editors here. It was also discussed with an academic editor with relevant expertise, and sent to independent reviewers, including a statistical reviewer. The reviews are appended at the bottom of this email and any accompanying reviewer attachments can be seen via the link below:

[LINK]

In light of these reviews, I am afraid that we will not be able to accept the manuscript for publication in the journal in its current form, but we would like to consider a revised version that addresses the reviewers' and editors' comments. Obviously we cannot make any decision about publication until we have seen the revised manuscript and your response, and we plan to seek re-review by one or more of the reviewers.

In revising the manuscript for further consideration, your revisions should address the specific points made by each reviewer and the editors. Please also check the guidelines for revised papers at http://journals.plos.org/plosmedicine/s/revising-your-manuscript for any that apply to your paper. In your rebuttal letter you should indicate your response to the reviewers' and editors' comments, the changes you have made in the manuscript, and include either an excerpt of the revised text or the location (eg: page and line number) where each change can be found. Please submit a clean version of the paper as the main article file; a version with changes marked should be uploaded as a marked up manuscript.

In addition, we request that you upload any figures associated with your paper as individual TIF or EPS files with 300dpi resolution at resubmission; please read our figure guidelines for more information on our requirements: http://journals.plos.org/plosmedicine/s/figures. While revising your submission, please upload your figure files to the PACE digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at PLOSMedicine@plos.org.

We expect to receive your revised manuscript by Feb 10 2020 11:59PM. Please email us (plosmedicine@plos.org) if you have any questions or concerns.

***Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out.***

We ask every co-author listed on the manuscript to fill in a contributing author statement, making sure to declare all competing interests. If any of the co-authors have not filled in the statement, we will remind them to do so when the paper is revised. If all statements are not completed in a timely fashion this could hold up the re-review process. If new competing interests are declared later in the revision process, this may also hold up the submission. Should there be a problem getting one of your co-authors to fill in a statement we will be in contact. YOU MUST NOT ADD OR REMOVE AUTHORS UNLESS YOU HAVE ALERTED THE EDITOR HANDLING THE MANUSCRIPT TO THE CHANGE AND THEY SPECIFICALLY HAVE AGREED TO IT. You can see our competing interests policy here: http://journals.plos.org/plosmedicine/s/competing-interests.

Please use the following link to submit the revised manuscript:

https://www.editorialmanager.com/pmedicine/

Your article can be found in the "Submissions Needing Revision" folder.

To enhance the reproducibility of your results, we recommend that you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. For instructions see http://journals.plos.org/plosmedicine/s/submission-guidelines#loc-methods.

Please ensure that the paper adheres to the PLOS Data Availability Policy (see http://journals.plos.org/plosmedicine/s/data-availability), which requires that all data underlying the study's findings be provided in a repository or as Supporting Information. For data residing with a third party, authors are required to provide instructions with contact information for obtaining the data. PLOS journals do not allow statements supported by "data not shown" or "unpublished results." For such statements, authors must provide supporting data or cite public sources that include it.

We look forward to receiving your revised manuscript.

Sincerely,

Adya Misra, PhD

Senior Editor

PLOS Medicine

plosmedicine.org

-----------------------------------------------------------

Requests from the editors:

Title: Please revise to adhere to PLOS Medicine style, include a colon and a study descriptor in the second half the title. For example “Evaluation of systems reform in Victorian public hospitals to improve access to antenatal care for women of refugee background: an interrupted time series design”

Abstract: please organise the abstract into “Introduction”, “Methods and Findings” followed by “Conclusions”. The last sentence of the methods and findings section should be a limitation of your methodology

Abstract: When reporting quantitative results, please be specific instead of using “about” or “around”

Abstract: please include participant demographics

Data availability statement- authors cannot be responsible for requests for data access and should be a third party such as an ethics committee

At this stage, we ask that you include a short, non-technical Author Summary of your research to make findings accessible to a wide audience that includes both scientists and non-scientists. The Author Summary should immediately follow the Abstract in your revised manuscript. This text is subject to editorial change and should be distinct from the scientific abstract. Please see our author guidelines for more information: https://journals.plos.org/plosmedicine/s/revising-your-manuscript#loc-author-summary

Please remove page numbers from the RECORD checklist as these are likely to change. Instead please use paragraphs and sections

Did your study have a prospective protocol or analysis plan? Please state this (either way) early in the Methods section.

a) If a prospective analysis plan (from your funding proposal, IRB or other ethics committee submission, study protocol, or other planning document written before analyzing the data) was used in designing the study, please include the relevant prospectively written document with your revised manuscript as a Supporting Information file to be published alongside your study, and cite it in the Methods section. A legend for this file should be included at the end of your manuscript.

b) If no such document exists, please make sure that the Methods section transparently describes when analyses were planned, and when/why any data-driven changes to analyses took place.

c) In either case, changes in the analysis—including those made in response to peer review comments—should be identified as such in the Methods section of the paper, with rationale.

Comments from the reviewers:

Reviewer #1: I confine my remarks to statistical aspects of this paper. The general approach is fine but I have one suggestion and a few concerns that need to be addressed before I can recommend publication.

The authors use logistic regression. This isn't exactly wrong, but, by dichotomizing the outcomes they lose power and lose some ability to answer interesting questions. I suggest using some sort of count regression (e.g. negative binomial) model for the first aim and Cox models for the second aim.

In addition, the authors need to assess the assumptions of ITS analysis. In particular 1) Linear trend prior to intervention. Unless I am missing something, there are only 2 time points before the initervention, so this can't be assessed, but the assumption has to be mentioned. 2) That the characteristics of the population do not change over the course of the study.

More specific:

Table 3 - I don't think age should be categorized; certainly not this way. Maybe use some sort of density plot, or maybe combine the youngest and oldest into a "high risk" category Also it isn't clear what the p value here is testing. Chi-square? Some sort of trend measure?

Figures - making the y axis go from 0 to 100 does show the full possible range, but it obscures the trends. Consider using 50 to 100,

Peter Flom.

Reviewer #2: Reviewer Report

Manuscript Title: 'Bridging the Gap': Systems reform in Victorian public hospitals to improve access to antenatal care for women of refugee background evaluated using an interrupted time series design

The manuscript is an insightful study based on two sets of expectant women, one - who sought refuge in Australia compared to two - native Australian women employing an interrupted time series analysis. The study is detailed and systematic with regard to the reported findings and results. The author(s) have employed a multivariate logistic regression model to determine the objectives of the study as well. They have mindfully reported the weaknesses of the study, especially with the limited time points employed in the time series. The findings procured with the multivariate logistic regression model spotlights answers to the research questions that the study attempts to investigate.

The following points incorporated in the forthcoming draft would further enrich the contents of the manuscript enabling the reader with a better perspective of the study:

1. The manuscript has concise information about the 'Bridging the Gap' (BG) initiative which is the principal intervention of the study.

a. Creating a new Background Information section that includes the aims, objectives, purpose, target metrics and milestones, vision and goals of the BG initiative would help the reader draw sufficient information about the BG initiative. This step is important because the BG initiative needs to be described adequately as the context of the paper revolves around it.

2. The draft makes a mention of the hospitals that the two sets of expectant mothers visited for the study; however, it does not mention the inclusion and exclusion criteria of the selected hospitals.

a. Adding the inclusion and exclusion criteria of the hospitals in the Methods section is essential to further inform the reader about the demographics of the sample population of expectant mothers who visited the hospitals leveraged for the study.

Overall, I would recommend acceptance of the manuscript with incorporations of the above two points.

Sincerely,

Dr. Shenoy

Dr. Amrita G. Shenoy, PhD, MBA, MHA, MSc

Assistant Professor and Graduate Program Director

Health Systems Management Program

School of Health and Human Services

College of Public Affairs

University of Baltimore

1420 N. Charles Street, Baltimore, Maryland, 21201 USA

Reviewer #3: This is a fascinating study where the authors analyze the population of women receiving antenatal care at two hospital networks and try to assess differences based on refugee/immigration status. It would be interesting to try to tie this information to outcomes such as stillbirths, premature deliveries, obstetrical complications, maternal deaths. Could the authors do this?

could the authors comment on the link between antenatal care and outcomes in general.

The authors note that there is a higher incidence of poor birth outcomes amongst refugees yet by their data, there is a similar rate of antenatal visits of refugee women and Australian born women. Could the authors comment about this?

Any attachments provided with reviews can be seen via the following link:

[LINK]

Attachments
Attachment
Submitted filename: Bridging the Gap_PLOS_Reviewer Report.docx
Revision 1
Decision Letter - Adya Misra, Editor

Dear Dr. Yelland,

Thank you very much for re-submitting your manuscript "Evaluation of systems reform in Victorian public hospitals to improve access to antenatal care for women of refugee background: an interrupted time series design" (PMEDICINE-D-19-03494R1) for review by PLOS Medicine.

I have discussed the paper with my colleagues and the academic editor and it was also seen again by xxx reviewers. I am pleased to say that provided the remaining editorial and production issues are dealt with we are planning to accept the paper for publication in the journal.

The remaining issues that need to be addressed are listed at the end of this email. Any accompanying reviewer attachments can be seen via the link below. Please take these into account before resubmitting your manuscript:

[LINK]

Our publications team (plosmedicine@plos.org) will be in touch shortly about the production requirements for your paper, and the link and deadline for resubmission. DO NOT RESUBMIT BEFORE YOU'VE RECEIVED THE PRODUCTION REQUIREMENTS.

***Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out.***

In revising the manuscript for further consideration here, please ensure you address the specific points made by each reviewer and the editors. In your rebuttal letter you should indicate your response to the reviewers' and editors' comments and the changes you have made in the manuscript. Please submit a clean version of the paper as the main article file. A version with changes marked must also be uploaded as a marked up manuscript file.

Please also check the guidelines for revised papers at http://journals.plos.org/plosmedicine/s/revising-your-manuscript for any that apply to your paper. If you haven't already, we ask that you provide a short, non-technical Author Summary of your research to make findings accessible to a wide audience that includes both scientists and non-scientists. The Author Summary should immediately follow the Abstract in your revised manuscript. This text is subject to editorial change and should be distinct from the scientific abstract.

We expect to receive your revised manuscript within 1 week. Please email us (plosmedicine@plos.org) if you have any questions or concerns.

We ask every co-author listed on the manuscript to fill in a contributing author statement. If any of the co-authors have not filled in the statement, we will remind them to do so when the paper is revised. If all statements are not completed in a timely fashion this could hold up the re-review process. Should there be a problem getting one of your co-authors to fill in a statement we will be in contact. YOU MUST NOT ADD OR REMOVE AUTHORS UNLESS YOU HAVE ALERTED THE EDITOR HANDLING THE MANUSCRIPT TO THE CHANGE AND THEY SPECIFICALLY HAVE AGREED TO IT.

Please ensure that the paper adheres to the PLOS Data Availability Policy (see http://journals.plos.org/plosmedicine/s/data-availability), which requires that all data underlying the study's findings be provided in a repository or as Supporting Information. For data residing with a third party, authors are required to provide instructions with contact information for obtaining the data. PLOS journals do not allow statements supported by "data not shown" or "unpublished results." For such statements, authors must provide supporting data or cite public sources that include it.

If you have any questions in the meantime, please contact me or the journal staff on plosmedicine@plos.org.

We look forward to receiving the revised manuscript by Feb 26 2020 11:59PM.

Sincerely,

Adya Misra, PhD

Senior Editor

PLOS Medicine

plosmedicine.org

------------------------------------------------------------

Requests from Editors:

Title – can Australia be worked in please?

Abstract - I think some more summary demographic information in the abstract may be useful including mean age and add months to the dates. Please add not sufficiently powered to limitations? (as in line 207)

Author summary -please include bullet points

Author summary- lines 41 and 42 perhaps not needed here

Please provide hospital names participating in Victoria so the study findings are more relevant. Please consider including a map of Victoria indicating the spread of sites participating, city names in Victoria if hospital names could be potentially identifying.

Lines 44,45 we suggest you revise to “we co-designed and implemented multiple quality improvement and demonstration initiatives in universal health services, including four maternity hospitals”

Lines 48-49- perhaps not relevant here? Suggest removing and incorporating in a previous point

Line 58-60 perhaps not relevant here and we suggest removing

Is this a significant limitation that could cause overestimation? Please discuss in the conclusions as required : Country of birth was considered the best available proxy measure for identifying women of refugee background in routinely collected hospital data systems

References- when citing multiple sources, please use single brackets for example Line 356 [27,28]

Data – "some restrictions", please indicate what these restrictions (ethical, consent related etc) are and if data might be available on request. Please note that authors cannot be data contacts.

Comments from Reviewers:

Reviewer #1: The authors have responded to most of my issues satsifactorily. One remain issue. REgarding table 3, I wrote, asking them not to categorize age. They responded:

<<<

The categorisation helps with accessibility of the findings and allows for non-linearity in either risk or access according to age. As noted the youngest and oldest women would often experience the highest risks in

epidemiological studies but this may be due to very different social, biological and behavioural profiles so it would be a preference to keep these groups distinct

>>>

This is incorrect. Categorization often *obscures* nonlinearities, rather than illuminating them. I show some of this in my blog post https://medium.com/@peterflom/what-happens-when-we-categorize-an-independent-variable-in-regression-77d4c5862b6c

Peter Flom

Any attachments provided with reviews can be seen via the following link:

[LINK]

Attachments
Attachment
Submitted filename: Response to reviews 8th February 2020.docx
Revision 2
Decision Letter - Adya Misra, Editor

Dear Dr. Yelland,

Thank you very much for submitting your manuscript "Evaluation of systems reform in Victoria, Australia, public hospitals to improve access to antenatal care for women of refugee background: an interrupted time series design" (PMEDICINE-D-19-03494R2) for consideration at PLOS Medicine.

Your paper was evaluated by a senior editor and discussed among all the editors here. It was also discussed with an academic editor with relevant expertise, and sent to independent reviewers, including a statistical reviewer. The reviews are appended at the bottom of this email and any accompanying reviewer attachments can be seen via the link below:

[LINK]

Your response to comments from the statistical reviewer do not meet our requirements for publication and therefore we ask that you present age as a continuous variable, not a categorical variable. We will then seek additional review of the manuscript after you have undertaken the necessary revisions.

In light of these reviews, I am afraid that we will not be able to accept the manuscript for publication in the journal in its current form, but we would like to consider a revised version that addresses the reviewers' and editors' comments. Obviously we cannot make any decision about publication until we have seen the revised manuscript and your response, and we plan to seek re-review by one or more of the reviewers.

In revising the manuscript for further consideration, your revisions should address the specific points made by each reviewer and the editors. Please also check the guidelines for revised papers at http://journals.plos.org/plosmedicine/s/revising-your-manuscript for any that apply to your paper. In your rebuttal letter you should indicate your response to the reviewers' and editors' comments, the changes you have made in the manuscript, and include either an excerpt of the revised text or the location (eg: page and line number) where each change can be found. Please submit a clean version of the paper as the main article file; a version with changes marked should be uploaded as a marked up manuscript.

In addition, we request that you upload any figures associated with your paper as individual TIF or EPS files with 300dpi resolution at resubmission; please read our figure guidelines for more information on our requirements: http://journals.plos.org/plosmedicine/s/figures. While revising your submission, please upload your figure files to the PACE digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at PLOSMedicine@plos.org.

We expect to receive your revised manuscript by Apr 03 2020 11:59PM. Please email us (plosmedicine@plos.org) if you have any questions or concerns.

***Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out.***

We ask every co-author listed on the manuscript to fill in a contributing author statement, making sure to declare all competing interests. If any of the co-authors have not filled in the statement, we will remind them to do so when the paper is revised. If all statements are not completed in a timely fashion this could hold up the re-review process. If new competing interests are declared later in the revision process, this may also hold up the submission. Should there be a problem getting one of your co-authors to fill in a statement we will be in contact. YOU MUST NOT ADD OR REMOVE AUTHORS UNLESS YOU HAVE ALERTED THE EDITOR HANDLING THE MANUSCRIPT TO THE CHANGE AND THEY SPECIFICALLY HAVE AGREED TO IT. You can see our competing interests policy here: http://journals.plos.org/plosmedicine/s/competing-interests.

Please use the following link to submit the revised manuscript:

https://www.editorialmanager.com/pmedicine/

Your article can be found in the "Submissions Needing Revision" folder.

To enhance the reproducibility of your results, we recommend that you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. For instructions see http://journals.plos.org/plosmedicine/s/submission-guidelines#loc-methods.

Please ensure that the paper adheres to the PLOS Data Availability Policy (see http://journals.plos.org/plosmedicine/s/data-availability), which requires that all data underlying the study's findings be provided in a repository or as Supporting Information. For data residing with a third party, authors are required to provide instructions with contact information for obtaining the data. PLOS journals do not allow statements supported by "data not shown" or "unpublished results." For such statements, authors must provide supporting data or cite public sources that include it.

We look forward to receiving your revised manuscript.

Sincerely,

Adya Misra, PhD

Senior Editor

PLOS Medicine

plosmedicine.org

-----------------------------------------------------------

Requests from the editors:

Comments from the reviewers:

Any attachments provided with reviews can be seen via the following link:

[LINK]

Attachments
Attachment
Submitted filename: Response to revision 20 Feb 2020 2.docx
Revision 3
Decision Letter - Adya Misra, Editor

Dear Dr. Yelland,

Thank you very much for re-submitting your manuscript "Evaluation of systems reform in Victoria, Australia, public hospitals to improve access to antenatal care for women of refugee background: an interrupted time series design" (PMEDICINE-D-19-03494R3) for review by PLOS Medicine.

I have discussed the paper with my colleagues and the academic editor and it was also seen again by xxx reviewers. I am pleased to say that provided the remaining editorial and production issues are dealt with we are planning to accept the paper for publication in the journal.

The remaining issues that need to be addressed are listed at the end of this email. Any accompanying reviewer attachments can be seen via the link below. Please take these into account before resubmitting your manuscript:

[LINK]

Our publications team (plosmedicine@plos.org) will be in touch shortly about the production requirements for your paper, and the link and deadline for resubmission. DO NOT RESUBMIT BEFORE YOU'VE RECEIVED THE PRODUCTION REQUIREMENTS.

***Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out.***

In revising the manuscript for further consideration here, please ensure you address the specific points made by each reviewer and the editors. In your rebuttal letter you should indicate your response to the reviewers' and editors' comments and the changes you have made in the manuscript. Please submit a clean version of the paper as the main article file. A version with changes marked must also be uploaded as a marked up manuscript file.

Please also check the guidelines for revised papers at http://journals.plos.org/plosmedicine/s/revising-your-manuscript for any that apply to your paper. If you haven't already, we ask that you provide a short, non-technical Author Summary of your research to make findings accessible to a wide audience that includes both scientists and non-scientists. The Author Summary should immediately follow the Abstract in your revised manuscript. This text is subject to editorial change and should be distinct from the scientific abstract.

We expect to receive your revised manuscript within 1 week. Please email us (plosmedicine@plos.org) if you have any questions or concerns.

We ask every co-author listed on the manuscript to fill in a contributing author statement. If any of the co-authors have not filled in the statement, we will remind them to do so when the paper is revised. If all statements are not completed in a timely fashion this could hold up the re-review process. Should there be a problem getting one of your co-authors to fill in a statement we will be in contact. YOU MUST NOT ADD OR REMOVE AUTHORS UNLESS YOU HAVE ALERTED THE EDITOR HANDLING THE MANUSCRIPT TO THE CHANGE AND THEY SPECIFICALLY HAVE AGREED TO IT.

Please ensure that the paper adheres to the PLOS Data Availability Policy (see http://journals.plos.org/plosmedicine/s/data-availability), which requires that all data underlying the study's findings be provided in a repository or as Supporting Information. For data residing with a third party, authors are required to provide instructions with contact information for obtaining the data. PLOS journals do not allow statements supported by "data not shown" or "unpublished results." For such statements, authors must provide supporting data or cite public sources that include it.

If you have any questions in the meantime, please contact me or the journal staff on plosmedicine@plos.org.

We look forward to receiving the revised manuscript by May 26 2020 11:59PM.

Sincerely,

Adya Misra, PhD

Senior Editor

PLOS Medicine

plosmedicine.org

------------------------------------------------------------

Requests from Editors:

Please format the bibliography in Vancouver style

Please use paragraph and section numbers in the RECORD checklist instead of using page numbers as these are likely to change during publication. Could you also rename the file to read "RECORD" instead of "STROBE"

Comments from Reviewers:

Reviewer #1: The authors have responded to my concerns and I now recommend publication

Peter Flom

Any attachments provided with reviews can be seen via the following link:

[LINK]

Attachments
Attachment
Submitted filename: Response_3rd April 2020.docx
Revision 4
Decision Letter - Adya Misra, Editor

Dear Dr. Yelland,

On behalf of my colleagues and the academic editor, Dr. Paul Spiegel, I am delighted to inform you that your manuscript entitled "Evaluation of systems reform in public hospitals, Victoria, Australia, to improve access to antenatal care for women of refugee background: an interrupted time series design" (PMEDICINE-D-19-03494R4) has been accepted for publication in PLOS Medicine.

PRODUCTION PROCESS

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If you are likely to be away when either this document or the proof is sent, please ensure we have contact information of a second person, as we will need you to respond quickly at each point.

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A selection of our articles each week are press released by the journal. You will be contacted nearer the time if we are press releasing your article in order to approve the content and check the contact information for journalists is correct. If your institution or institutions have a press office, please notify them about your upcoming paper at this point, to enable them to help maximize its impact.

PROFILE INFORMATION

Now that your manuscript has been accepted, please log into EM and update your profile. Go to https://www.editorialmanager.com/pmedicine, log in, and click on the "Update My Information" link at the top of the page. Please update your user information to ensure an efficient production and billing process.

Thank you again for submitting the manuscript to PLOS Medicine. We look forward to publishing it.

Best wishes,

Adya Misra, PhD

Senior Editor

PLOS Medicine

plosmedicine.org

Attachments
Attachment
Submitted filename: Response to production issues.docx

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