TY - JOUR

T1 - Improving systems of care during and after a pregnancy complicated by hyperglycaemia

T2 - A protocol for a complex health systems intervention

AU - MacKay, D.

AU - Kirkham, R.

AU - Freeman, N.

AU - Murtha, K.

AU - Van Dokkum, P.

AU - Boyle, J.

AU - Campbell, S.

AU - Barzi, F.

AU - Connors, C.

AU - O'Dea, K.

AU - Oats, J.

AU - Zimmet, P.

AU - Wenitong, M.

AU - Sinha, A.

AU - Hanley, A. J.

AU - Moore, E.

AU - Peiris, D.

AU - McLean, A.

AU - Davis, B.

AU - Whitbread, C.

AU - McIntyre, H. D.

AU - Mein, J.

AU - McDermott, R.

AU - Corpus, S.

AU - Canuto, K.

AU - Shaw, J. E.

AU - Brown, A.

AU - Maple-Brown, L.

AU - Webster, Vanya

AU - Graham, Sian

AU - Bell, Dianne

AU - Keeler, Katarina

AU - Wapau, Chenoa

AU - Zachariah, Martil

AU - Barrett, Jennifer

AU - Dias, Tara

AU - Vine, Kristina

AU - Davis, Bronwyn

AU - Chitturi, S.

AU - Eades, S.

AU - Inglis, C.

AU - Dempsey, K.

AU - Lynch, M.

AU - Skinner, T.

AU - Wright, R.

PY - 2020

Y1 - 2020

N2 - Background: Many women with hyperglycaemia in pregnancy do not receive care during and after pregnancy according to standards recommended in international guidelines. The burden of hyperglycaemia in pregnancy falls disproportionately upon Indigenous peoples worldwide, including Aboriginal and Torres Strait Islander women in Australia. The remote and regional Australian context poses additional barriers to delivering healthcare, including high staff turnover and a socially disadvantaged population with a high prevalence of diabetes. Methods: A complex health systems intervention to improve care for women during and after a pregnancy complicated by hyperglycaemia will be implemented in remote and regional Australia (the Northern Territory and Far North Queensland). The Theoretical Domains Framework was used during formative work with stakeholders to identify intervention components: (1) increasing workforce capacity, skills and knowledge and improving health literacy of health professionals and women; (2) improving access to healthcare through culturally and clinically appropriate pathways; (3) improving information management and communication; (4) enhancing policies and guidelines; (5) embedding use of a clinical register as a quality improvement tool. The intervention will be evaluated utilising the RE-AIM framework at two timepoints: firstly, a qualitative interim evaluation involving interviews with stakeholders (health professionals, champions and project implementers); and subsequently a mixed-methods final evaluation of outcomes and processes: interviews with stakeholders; survey of health professionals; an audit of electronic health records and clinical register; and a review of operational documents. Outcome measures include changes between pre- and post-intervention in: proportion of high risk women receiving recommended glucose screening in early pregnancy; diabetes-related birth outcomes; proportion of women receiving recommended postpartum care including glucose testing; health practitioner confidence in providing care, knowledge and use of relevant guidelines and referral pathways, and perception of care coordination and communication systems; changes to health systems including referral pathways and clinical guidelines. Discussion: This study will provide insights into the impact of health systems changes in improving care for women with hyperglycaemia during and after pregnancy in a challenging setting. It will also provide detailed information on process measures in the implementation of such health system changes.

AB - Background: Many women with hyperglycaemia in pregnancy do not receive care during and after pregnancy according to standards recommended in international guidelines. The burden of hyperglycaemia in pregnancy falls disproportionately upon Indigenous peoples worldwide, including Aboriginal and Torres Strait Islander women in Australia. The remote and regional Australian context poses additional barriers to delivering healthcare, including high staff turnover and a socially disadvantaged population with a high prevalence of diabetes. Methods: A complex health systems intervention to improve care for women during and after a pregnancy complicated by hyperglycaemia will be implemented in remote and regional Australia (the Northern Territory and Far North Queensland). The Theoretical Domains Framework was used during formative work with stakeholders to identify intervention components: (1) increasing workforce capacity, skills and knowledge and improving health literacy of health professionals and women; (2) improving access to healthcare through culturally and clinically appropriate pathways; (3) improving information management and communication; (4) enhancing policies and guidelines; (5) embedding use of a clinical register as a quality improvement tool. The intervention will be evaluated utilising the RE-AIM framework at two timepoints: firstly, a qualitative interim evaluation involving interviews with stakeholders (health professionals, champions and project implementers); and subsequently a mixed-methods final evaluation of outcomes and processes: interviews with stakeholders; survey of health professionals; an audit of electronic health records and clinical register; and a review of operational documents. Outcome measures include changes between pre- and post-intervention in: proportion of high risk women receiving recommended glucose screening in early pregnancy; diabetes-related birth outcomes; proportion of women receiving recommended postpartum care including glucose testing; health practitioner confidence in providing care, knowledge and use of relevant guidelines and referral pathways, and perception of care coordination and communication systems; changes to health systems including referral pathways and clinical guidelines. Discussion: This study will provide insights into the impact of health systems changes in improving care for women with hyperglycaemia during and after pregnancy in a challenging setting. It will also provide detailed information on process measures in the implementation of such health system changes.

KW - Aboriginal

KW - diabetes in pregnancy

KW - gestational diabetes

KW - health services

KW - health systems

KW - healthcare delivery

KW - Indigenous Australian

KW - mixed methods evaluation

KW - Torres Strait Islander

KW - type 2 diabetes in pregnancy

U2 - 10.1186/s12913-020-05680-x

DO - 10.1186/s12913-020-05680-x

M3 - Journal article

C2 - 32867837

AN - SCOPUS:85090107347

VL - 20

JO - BMC Health Services Research

JF - BMC Health Services Research

SN - 1472-6963

IS - 1

M1 - 814

ER -