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. 2022 Aug 15;22(1):639.
doi: 10.1186/s12884-022-04867-w.

The Tommy's Clinical Decision Tool, a device for reducing the clinical impact of placental dysfunction and preterm birth: protocol for a mixed-methods early implementation evaluation study

Jenny Carter  1   2 , Dilly Anumba  3   4 , Lia Brigante  3   5 , Christy Burden  3   6 , Tim Draycott  3   7 , Siobhán Gillespie  3   4 , Birte Harlev-Lam  3   5 , Andrew Judge  3   8 , Erik Lenguerrand  3   8 , Elaine Sheehan  3   9   10 , Basky Thilaganathan  3   10   11 , Hannah Wilson  12   3 , Cathy Winter  3   13 , Maria Viner  3   14 , Jane Sandall  12   3
Affiliations

The Tommy's Clinical Decision Tool, a device for reducing the clinical impact of placental dysfunction and preterm birth: protocol for a mixed-methods early implementation evaluation study

Jenny Carter et al. BMC Pregnancy Childbirth. .

Abstract

Background: Disparities in stillbirth and preterm birth persist even after correction for ethnicity and social deprivation, demonstrating that there is wide geographical variation in the quality of care. To address this inequity, Tommy's National Centre for Maternity Improvement developed the Tommy's Clinical Decision Tool, which aims to support the provision of "the right care at the right time", personalising risk assessment and care according to best evidence. This web-based clinical decision tool assesses the risk of preterm birth and placental dysfunction more accurately than current methods, and recommends best evidenced-based care pathways in a format accessible to both women and healthcare professionals. It also provides links to reliable sources of pregnancy information for women. The aim of this study is to evaluate implementation of Tommy's Clinical Decision Tool in four early-adopter UK maternity services, to inform wider scale-up.

Methods: The Tommy's Clinical Decision Tool has been developed involving maternity service users and healthcare professionals in partnership. This mixed-methods study will evaluate: maternity service user and provider acceptability and experience; barriers and facilitators to implementation; reach (whether particular groups are excluded and why), fidelity (degree to which the intervention is delivered as intended), and unintended consequences. Data will be gathered over 25 months through interviews, focus groups, questionnaires and through the Tommy's Clinical Decision Tool itself. The NASSS framework (Non-adoption or Abandonment of technology by individuals and difficulties achieving Scale-up, Spread and Sustainability) will inform data analysis.

Discussion: This paper describes the intervention, Tommy's Clinical Decision Tool, according to TiDIER guidelines, and the protocol for the early adopter implementation evaluation study. Findings will inform future scale up.

Trial registration: This study was prospectively registered on the ISRCTN registry no. 13498237 , on 31st January 2022.

Keywords: Decision support; Implementation; Pregnancy; Preterm; Process evaluation; Risk assessment; Stillbirth; eHealth.

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Conflict of interest statement

JS is Head of Maternity and Midwifery Research at NHS England and NHS Improvement. EL is a member of the University of Bristol (UoB) and part of his salary until 31/7/2021 was paid by the PROMPT Maternity Foundation (PMF) to UoB. He has no conflict of interest since then. All other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Overview of Tommy's Clinical Decision Tool Implementation and Evaluation Programme
Fig. 2
Fig. 2
Tommy's Clinical Decision Tool dual interface: example of placental function assessment
Fig. 3
Fig. 3
Tommy's Clinical Decision Tool touchpoints for risk assessment
Fig. 4
Fig. 4
The relationship between Study Work Packages and Implementation Outcomes
See this image and copyright information in PMC

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