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

Abstract

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.

Evaluation of standard and enhanced quality improvement methods to increase the uptake of magnesium sulfate in preterm deliveries for the prevention of neurodisability (PReCePT Study): a cluster randomized controlled trial

“…MgSO 4 uptake increased across maternity units in the NPP. Overall, the NPP was effective and cost-effective (full evaluation reported elsewhere(11)) The enhanced support model did not appear to improve MgSO 4 uptake beyond the gains seen in the standard NPP support model. This indicates that the enhanced support would not be justified on a universal national scale.…”

Economic evaluation in implementation science: A reconciled approach evaluating programmes to increase the uptake of magnesium sulphate in pre-term births

“…MgSO 4 uptake appears to be stabilised at a little over 80% [40] from the second half of 2019 up to June 2020.…”

“…MgSO4 uptake appears to be stabilised at a little over 80% [40] from the second half of 2019 up to June 2020. Considering 3,400 pre-term babies being born nationally in a year, the perfect implementation would increase the uptake from 80% to 95%, which is 15%.…”

Quality improvement interventions to increase the uptake of magnesium sulphate in preterm deliveries for the prevention of cerebral palsy (PReCePT study): a cluster randomised controlled trial

“…10 The National PReCePT Programme (NPP) scaled-up the intervention and it was rolled-out across English maternity units, led by regional Academic Health Science Networks (AHSNs), to increase MgSO 4 uptake to 85% by 2020. 11 A cluster randomised controlled trial (cRCT) was nested within the NPP. It evaluated the effectiveness and costeffectiveness of the enhanced support model, compared with the standard NPP support model.…”

“…The pilot study (five maternity units) improved MgSO 4 uptake from 21% in 2012–2013 to 88% in 2015 10 . The National PReCePT Programme (NPP) scaled‐up the intervention and it was rolled‐out across English maternity units, led by regional Academic Health Science Networks (AHSNs), to increase MgSO 4 uptake to 85% by 2020 11 …”