Alberta Collaborative Quality Improvement Strategies to Improve Outcomes of Moderate and Late Preterm Infants (ABC-QI) Trial: a protocol for a multicentre, stepped-wedge cluster randomized trial

CMAJ Open · 20 authors, 1 centre

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TL;DR

This protocol describes a 4-year, multicentre, stepped-wedge cluster randomized trial across 12 NICUs in Alberta, Canada, evaluating whether EPIQ collaborative quality improvement strategies reduce length of stay and improve outcomes in moderate and late preterm neonates born at 32–36 weeks' gestation.

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This is a protocol for the ABC-QI Trial, a multicentre stepped-wedge cluster randomized trial involving 12 NICUs across Alberta, Canada. Twelve NICUs will be randomized to transition from current practice to EPIQ collaborative quality improvement strategies at three time points, with four NICUs transitioning each year after a baseline year. The primary outcome is length of hospital stay; secondary outcomes include cost to the health care system and short-term clinical outcomes.

STUDY TYPE

other

SPECIALTY

pediatrics

SUMMARISED BY

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ORIGINAL PAPER

PMC10158756

Alberta Collaborative Quality Improvement Strategies to Improve Outcomes of Moderate and Late Preterm Infants (ABC-QI) Trial: a protocol for a multicentre, stepped-wedge cluster randomized trial

CMAJ Open

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ABSTRACT

Background: Evidence-based Practice for Improving Quality (EPIQ) is a collaborative quality improvement method adopted by the Canadian Neonatal Network that led to decreased mortality and morbidity in very preterm neonates. The Alberta Collaborative Quality Improvement Strategies to Improve Outcomes of Moderate and Late Preterm Infants (ABC-QI) Trial aims to evaluate the impact of EPIQ collaborative quality improvement strategies in moderate and late preterm neonates in Alberta, Canada. Methods: In a 4-year, multicentre, stepped-wedge cluster randomized trial involving 12 neonatal intensive care units (NICUs), we will collect baseline data with the current practices in the first year (all NICUs in the control arm). Four NICUs will transition to the intervention arm at the end of each year, with 1 year of follow-up after the last group transitions to the intervention arm. Neonates born at 32 + 0 to 36 + 6 weeks’ gestation with primary admission to NICUs or postpartum units will be included. The intervention includes implementation of respiratory and nutritional care bundles using EPIQ strategies, including quality improvement team building, quality improvement education, bundle implementation, quality improvement mentoring and collaborative networking. The primary outcome is length of hospital stay; secondary outcomes include health care costs and short-term clinical outcomes. Neonatal intensive care unit staff will complete a survey in the first year to assess quality improvement culture in each unit, and a sample will be interviewed 1 year after implementation in each unit to evaluate the implementation process. Interpretation: The ABC-QI Trial will assess whether collaborative quality improvement strategies affect length of stay in moderate and late preterm neonates. It will provide detailed population-based data to support future research, benchmarking and quality improvement. Trial registration: ClinicalTrials.gov , no. NCT05231200

CITATION EXPORT

Ayman Abou Mehrem, Jennifer Toye, Khalid Aziz et al.. Alberta Collaborative Quality Improvement Strategies to Improve Outcomes of Moderate and Late Preterm Infants (ABC-QI) Trial: a protocol for a multicentre, stepped-wedge cluster randomized trial. CMAJ Open. (2023). https://doi.org/10.9778/cmajo.20220177

AUTHORS

20 · 1 CENTRES

Ayman Abou Mehrem, Jennifer Toye, Khalid Aziz, Karen Benzies, Belal Alshaikh, David Johnson, Peter Faris, Amuchou Soraisham, Deborah McNeil, Yazid N. Al Hamarneh, Karen Foss, Charlotte Foulston, Christine Johns, Gabrielle L. Zimmermann, Hussein Zein, Leonora Hendson, Kumar Kumaran, Dana Price, Nalini Singhal, Prakesh S. Shah

Department of Pediatrics (Abou Mehrem, Alshaikh, Johnson, Soraisham, Foulston, Zein, Hendson, Price, Singhal), Cumming School of Medicine and Alberta Children’s Hospital Research Institute (Abou Mehrem, Benzies, Alshaikh, Johnson, Soraisham, McNeil, Hendson, Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Toye, Kumaran) and Office of Lifelong Learning (Aziz), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Faculty of Nursing (Benzies), University of Calgary, Calgary, Alta.; Alberta Health Services (Faris, Foss, Foulston, Johns), Edmonton, Alta.; Community Health Sciences (Faris, McNeil, Zimmermann), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Alberta SPOR SUPPORT Unit (Al Hamarneh, Zimmermann); Department of Pharmacology (Al Hamarneh), Faculty of Medicine and Dentistry, University of Alberta; Covenant Health (Foss), Edmonton, Alta.; Department of Pediatrics (Shah), Mount Sinai Hospital; Department of Pediatrics (Shah), University of Toronto, Toronto, Ont.