National PReCePT Programme: a quasi-experimental before-and-after evaluation of the implementation of a national quality improvement programme to increase the uptake of magnesium sulphate in pre-term deliveries

ABSTRACT Objective To evaluate the effectiveness and cost-effectiveness of the National PreCePT Programme (NPP) in increasing magnesium sulphate (MgSO 4 ) in pre-term births. Design A quasi-experimental before-and-after design Setting Maternity units within NHS England and the AHSN network in 2018. Participants Maternity units in England (n=137) who participated in the NPP. Interventions NPP support which included the PReCePT QI toolkit and materials (pre-term labour proforma, staff training presentations, parent leaflet, posters for the unit, learning log), regional AHSN level support, and up to 90 hours funded backfill for a midwife ‘champion’ to lead implementation. Main outcome measures MgSO 4 post-implementation uptake compared to pre-implementation uptake. Implementation and lifetime costs were estimated. Results Compared to pre-implementation estimates, the average MgSO 4 uptake 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 or 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%. Conclusion This 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. WHAT IS ALREADY KNOWN ON THIS TOPIC Since 2015 the UK National Institute for Health and Care Excellence (NICE) has recommended administration of Magnesium Sulphate (MgSO 4 ) for fetal neuroprotection in very preterm deliveries as a core part of maternity care. By 2017, only two-thirds of all eligible women in England were being given MgSO 4 , with wide regional variation. The PReCePT pilot study showed an increase in uptake from 21% (2012-2013) to 88% after the introduction of the tool in2015 in 5 units. The National PReCePT Programme (NPP) was rolled out in 2018 by the national network of Academic Health Science Networks with a target to increase MgSO 4 administration in England to 85% by 2020. WHAT THIS STUDY ADDS The study has shown that the nationwide implementation of the NPP, which provided a Quality Improvement (QI) toolkit and materials, cross unit AHSN regional level support, and funded backfill for a unit midwife ‘champion’ through local regional support was effective and cost-effective. Scaling-up of network supported QI programmes at national level can accelerate uptake of new therapies and promote improvements in perinatal care delivery.