Jenny Carter has worked in maternal health research since 2003, supporting and leading high-quality trials and clinical studies. Most recently focusing on preterm birth and the award-winning St Thomas’ Preterm Surveillance Clinic, she established a novel patient and public involvement group and is a founder member of the UK Preterm Clinical Network. She led development of, and continues to manage, the Preterm Clinical Network Database (www.medscinet.net/ukpcn), capturing clinical data on women at risk of preterm birth for use in local audit and collaborative cohort studies. Her PhD work, which focused on risk assessment in threatened preterm labour and development of the QUiPP app, was supported by an NIHR Clinical Doctoral Research Fellowship and resulted in a KCL Outstanding PhD Thesis Prize. Since completing her PhD she was supported by an NIHR postdoctoral Development and Skills Enhancement Award, and is currently Research Fellow for the Tommy’s National Centre for Maternity Improvement.
Poor perinatal outcomes are more common in those living in areas of social deprivation and from ethnic minority groups. Causes of this disparity may be complex, but appear to include variation in care, as stillbirth and preterm birth rates vary between hospitals, even after adjustment for maternal characteristics. To address this variation in care, Tommy’s National Centre for Maternity Improvement developed the Tommy’s Clinical Decision Tool. This web-based tool assesses risk of preterm birth and placental dysfunction, which can lead to stillbirth, much more accurately than current methods, and recommends best evidenced-based care pathways in a format accessible to both women and healthcare professionals (HCPs). This study is evaluating implementation of the Tool in five early-adopter sites, to inform wider scale-up.
Tommy’s Tool development, including determination of risk parameters and care pathways, involved maternity service users and HCPs in equal partnership. This study is evaluating: maternity service user and provider 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 is gathered through interviews, focus groups, questionnaires and through the Tool itself. The NASSS framework (Non-adoption or Abandonment of technology by individuals and difficulties achieving Scale-up, Spread and Sustainability) is informing implementation and data analysis.
Findings to date have informed ongoing developments of the Tool and implementation strategy, including those aimed at addressing digital and social exclusion (e.g. one-to-one support, language translation, animations). Other notable findings include: need for persistent, high-level local leadership, local champions, flexibility in training.
Tommy’s Tool has the potential to make providing “the right care at the right time” easier, personalising risk-assessment and care according to best evidence. Findings will inform implementation in scaling up in other settings.