Evaluation of Standard and Enhanced Quality Improvement Methods to Increase the Uptake of Magnesium Sulphate in Pre-Term Deliveries for the Prevention of Neurodisability (PReCePT Study): A Cluster Randomized Controlled Trial

Edwards, Hannah; Redaniel, Maria Theresa; Sillero‐Rejon, Carlos; Pithara, Christalla; Margelyte, Ruta; Stone, Tracey; Peters, Tim; McLeod, Hugh; Hollingworth, William; Hill, Elizabeth M.; Redwood, Sabi; Treloar, Emma; Donovan, Jenny; Opmeer, Brent C.; Luyt, Karen; Craggs, Pippa

doi:10.2139/ssrn.4071359

Cited by 3 publications

(6 citation statements)

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“…A nested cluster randomised trial to determine the effectiveness of standard versus enhanced support was conducted alongside the NPP. 8 This study was an effectiveness and cost-effectiveness evaluation of the NPP QI intervention in increasing MgSO 4 uptake in mothers at risk of giving birth ≤30 weeks' gestational age. We hypothesised that it would help increase MgSO 4 uptake beyond the expected increase due to the underlying trend rate.…”

Section: Original Researchmentioning

confidence: 99%

National PReCePT Programme: a before-and-after evaluation of the implementation of a national quality improvement programme to increase the uptake of magnesium sulfate in preterm deliveries

Edwards

Redaniel

Sillero‐Rejon

et al. 2023

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo evaluate the effectiveness and cost-effectiveness of the National PReCePT Programme (NPP) in increasing use of magnesium sulfate (MgSO4) in preterm births.DesignBefore-and-after study.SettingMaternity units (N=137) within NHS England and the Academic Health Science Network (AHSN) in 2018.ParticipantsBabies born ≤30 weeks’ gestation admitted to neonatal units in England.InterventionsThe NPP was a quality improvement (QI) intervention including the PReCePT (Preventing Cerebral Palsy in Pre Term labour) QI toolkit and materials (preterm labour proforma, staff training presentations, parent leaflet, posters for the unit and learning log), regional AHSN-level support, and up to 90 hours funded backfill for a midwife ‘champion’ to lead implementation.Main outcome measuresMgSO4uptake post implementation was compared with pre-NPP implementation uptake. Implementation and lifetime costs were estimated.ResultsCompared with pre-implementation estimates, the average MgSO4uptake for babies born ≤30 weeks’ gestation, in 137 maternity units in England, increased by 6.3 percentage points (95% CI 2.6 to 10.0 percentage points) to 83.1% post implementation, accounting for unit size, maternal, baby and maternity unit factors, time trends, and AHSN. Further adjustment for early/late initiation of NPP activities increased the estimate to 9.5 percentage points (95% CI 4.3 to 14.7 percentage points). From a societal and lifetime perspective, the health gains and cost savings associated with the NPP effectiveness generated a net monetary benefit of £866 per preterm baby and the probability of the NPP being cost-effective was greater than 95%.ConclusionThis national QI programme was effective and cost-effective. National programmes delivered via coordinated regional clinical networks can accelerate uptake of evidence-based therapies in perinatal care.

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Section: Original Researchmentioning

confidence: 99%

National PReCePT Programme: a before-and-after evaluation of the implementation of a national quality improvement programme to increase the uptake of magnesium sulfate in preterm deliveries

Edwards

Redaniel

Sillero‐Rejon

et al. 2023

Arch Dis Child Fetal Neonatal Ed

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“…The evaluations of the National PReCePT Programme and the embedded randomised controlled trial (the PReCePT QI study) showed that increases in the uptake of MgSO4 were achieved across all units in England irrespective of whether they received a standard or enhanced QI package (12,13). The qualitative process evaluations provided some explanation.…”

Section: Discussionmentioning

confidence: 99%

“…The overall design and methods have been described (12,13). Following an inductive analysis using the framework method (15), we used in NPT abductively [1] (16) to generate insights into the implementation, spread and scale-up processes and then related our data back to the mechanisms and outcomes explained by NPT to understand variation within and between elements of the data, and differences between the QI support packages (6, 14).…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Evaluations of the NPP, and the PReCePT study have reported the effectiveness of the standard package alone in increasing the uptake of MgSO4 across all units in England (12,13). The qualitative process evaluation of the PReCePT QI study also suggested that the standard package alone may be adequate for units delivering care within an implementation-enabling environment, but a more intensive support package may be needed to enable meaningful and sustained change in maternity units with less enabling environments (12). In this paper, we focus on the ndings of the process evaluations of the NPP and PReCePT QI study, using Normalisation Process Theory (6, 14) to further our understanding of what needs to happen to incorporate and scale up a new activity (administering MgSO4 to eligible women in preterm labour) into routine clinical practice across an entire healthcare system.…”

Section: Introductionmentioning

confidence: 99%

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Scaling up an intervention to protect preterm infants from neurodevelopmental disabilities – findings from a qualitative process evaluation comparing standard with enhanced Quality Improvement support packages for maternity units in England

Redwood

Pithara

Stone

et al. 2022

Preprint

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Background A Quality Improvement strategy (PReCePT) was used in a standard and intensive format to scale up a clinical intervention (administering magnesium sulphate to women in preterm labour) across all maternity units in England to protect prematurely born infants from neurodevelopmental disabilities. Formal evaluations reported the effectiveness of the standard package alone in increasing the administration of magnesium sulphate. In this paper, we focus on the findings of the process evaluations, using Normalisation Process Theory to explain how different implementation contexts generated the observed outcomes relating to normative and relational restructuring, and sustainment. Methods Interviews were conducted with key individuals in implementation leadership positions nationally and locally. Interviews were analysed initially using the framework method. We then engaged recursively with NPT constructs to generate generalisable insights with pragmatic applicability in other scenarios. Results In total, 72 interviews were conducted with good representation from units across England, and staff from the national Academic Health Science Network. We found that all units irrespective of whether they received a standard or enhanced QI package were successful in the ‘normative restructuring’ of their setting to enable magnesium sulphate to be administered. This suggests that this implementation outcome is necessary to achieve improvements. However, it may not be sufficient to sustain and normalise the changes once additional resources have been withdrawn. Sustainment, our findings suggest, required ‘relational restructuring’ to accommodate altered workflows and facilitate the sharing of responsibilities and tasks in daily practice. Relational restructuring was more likely to have been achieved units receiving enhanced QI support but also happened in units with standard QI support, especially in those where perinatal teamworking was already well established. Conclusion Unlike other large QI focused spread-and-scale programmes which failed to show any impact on outcomes, the PReCePT programme in both the enhanced and standard support packages led to improvements in the uptake of magnesium sulphate. The findings suggest that QI programmes interact with the enabling factors, such as strong interprofessional team working, already present in the setting. A standard package with minimal support was therefore sufficient in settings with enabling factors, but enhanced support was required in units where these were absent.

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Scaling up an intervention to protect preterm infants from neurodevelopmental disabilities — findings from a qualitative process evaluation comparing standard with enhanced quality improvement support packages for maternity units in England

et al. 2023

Self Cite

View full text Add to dashboard Cite

Background A quality improvement strategy (PReCePT) was used in a standard and enhanced format to scale up a clinical intervention (administering magnesium sulphate to women in preterm labour) across all maternity units in England to protect prematurely born infants from neurodevelopmental disabilities. Formal evaluations reported the effectiveness of the standard package alone in increasing the administration of magnesium sulphate. In this paper, we focus on the findings of the process evaluations, using normalisation process theory to explain how different implementation contexts generated the observed outcomes relating to normative and relational restructuring and sustainment. Methods Interviews were conducted with key individuals in implementation of leadership positions nationally and locally. Interviews were analysed initially using the framework method. We then engaged recursively with NPT constructs to generate generalisable insights with pragmatic applicability in other settings. Results In total, 72 interviews were conducted with good representation from units across England and staff from the National Academic Health Science Network. We found that all units irrespective of whether they received a standard or enhanced QI package were successful in the ‘normative restructuring’ of their setting to enable magnesium sulphate to be administered. This suggests that this implementation outcome is necessary to achieve improvements. However, it may not be sufficient to sustain the changes once additional resources have been withdrawn. Sustainment, our findings suggest, required ‘relational restructuring’ to accommodate altered workflows and facilitate the sharing of responsibilities and tasks in daily practice. Relational restructuring was more likely to have been achieved units receiving enhanced QI support but also happened in units with standard QI support, especially in those where perinatal team working was already well established. Conclusion Unlike other large QI-focused spread-and-scale programmes which failed to show any impact on outcomes, the PReCePT programme in both the enhanced and standard support packages led to improvements in the uptake of magnesium sulphate. The findings suggest that QI programmes interact with the enabling factors, such as strong interprofessional team working, already present in the setting. A standard package with minimal support was therefore sufficient in settings with enabling factors, but enhanced support was required in units where these were absent.

show abstract

Evaluation of Standard and Enhanced Quality Improvement Methods to Increase the Uptake of Magnesium Sulphate in Pre-Term Deliveries for the Prevention of Neurodisability (PReCePT Study): A Cluster Randomized Controlled Trial

Cited by 3 publications

References 12 publications

National PReCePT Programme: a before-and-after evaluation of the implementation of a national quality improvement programme to increase the uptake of magnesium sulfate in preterm deliveries

National PReCePT Programme: a before-and-after evaluation of the implementation of a national quality improvement programme to increase the uptake of magnesium sulfate in preterm deliveries

Scaling up an intervention to protect preterm infants from neurodevelopmental disabilities – findings from a qualitative process evaluation comparing standard with enhanced Quality Improvement support packages for maternity units in England

Scaling up an intervention to protect preterm infants from neurodevelopmental disabilities — findings from a qualitative process evaluation comparing standard with enhanced quality improvement support packages for maternity units in England

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