eRegCom – Quality Improvement Dashboard for healthcare providers and Targeted Client Communication to pregnant women using data from an electronic health registry to improve attendance and quality of antenatal care: study protocol for a multi-arm cluster randomized trial

Abstract

Background: This trial evaluates interventions that utilize data entered at point-of-care in the Palestinian maternal and child eRegistry to generate Quality Improvement Dashboards (QID) for healthcare providers and Targeted Client Communication (TCC) via short message service (SMS) to clients. The aim is to assess the effectiveness of the automated communication strategies from the eRegistry on improving attendance and quality of care for pregnant women.Methods: This four-arm cluster randomized controlled trial will be conducted in the West Bank and the Gaza Strip, Palestine, and includes 138 clusters (primary healthcare clinics) enrolling from 45 to 3000 pregnancies per year. The intervention tools are the QID and the TCC via SMS, automated from the eRegistry built on the District Health Information Software 2 (DHIS2) Tracker. The primary outcomes are appropriate screening and management of anemia, hypertension, and diabetes during pregnancy; and timely attendance to antenatal care. Primary analysis, at the individual-level taking the design effect of the clustering into account, will be done as intention-to-treat.Discussion: This trial, embedded in the implementation of the eRegistry in Palestine, will inform the use of digital health interventions as a health systems strengthening approach.Trial registration: ISRCTN, trial registration number: 10520687, registered 18 October 2018, http://www.isrctn.com/ISRCTN10520687

The effect of a digital targeted client communication intervention on pregnant women’s worries and satisfaction with antenatal care in Palestine–A cluster randomized controlled trial

“…This was a non-inferiority two-armed parallel cluster randomized trial, sub-sampled from the four-armed eRegCom trial (Trial registration number: ISRCTN10520687), following the Consolidating Standards of Reporting Trials (CONSORT) criteria for cluster randomized trials [ 28 ] described in detail elsewhere [ 29 ]. In short, the four arms include one arm with Quality Improvement Dashboards (QID) for healthcare providers; one with TCC via SMS to women; one with both QID and TCC via SMS; and one control arm.…”

“…An independent statistician performed the randomization for the eRegCom trial [ 29 ], where PHCs were randomized to the TCC; QID; TCC and QID; or control arm with equal allocation. The randomization was stratified by the national implementation phase of the eRegistry, and constrained on laboratory availability, ultrasound availability and the size of the PHCs.…”