Impact Evaluation of PRONTO Mexico

Walker, Dilys; Cohen, Susanna R.; Fritz, Jimena; Olvera-García, Marisela; Zelek, Sarah T.; Fahey, Jenifer; Romero-Martínez, Martín; Montoya-Rodríguez, Alejandra; Lamadrid‐Figueroa, Héctor

doi:10.1097/sih.0000000000000106

Cited by 71 publications

(13 citation statements)

References 26 publications

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“…Similar to this trial, a different simulated training in Mexico, Programa de Rescate Obstétrico y Neonatal Tratamiento Óptimo y Oportuno , reported improved clinical practices but no reduction in obstetric haemorrhage cases41—probably also because AMTSL was already well implemented.…”

Section: Discussionmentioning

confidence: 51%

Effect of the competency-basedHelping Mothers Survive Bleeding after Birth(HMS BAB) training on maternal morbidity: a cluster-randomised trial in 20 districts in Tanzania

et al. 2019

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BackgroundTraining health providers is an important strategy to improve health. We conducted a cluster-randomised two-arm trial in Tanzania to assess the effect of a 1-day competency-based training ‘Helping Mothers Survive Bleeding after Birth (HMS BAB)’ followed by eight weekly drills on postpartum haemorrhage (PPH)-related morbidity and mortality.MethodsTwenty districts in four purposefully selected regions in Tanzania included 61 facilities. The districts were randomly allocated using matched pairs to ensure similarity in terms of district health services in intervention and comparison districts. In the 10 intervention districts 331 health providers received the HMS BAB training. The other half continued with standard practices. We used the WHO’s near miss tool to collect information on severe morbidity (near misses) of all women admitted to study facilities. We performed interrupted time series analysis to estimate differences in the change of near miss per delivery rate and case fatality rates. We also assessed implementation of evidence-based preventive and basic management practices for PPH as secondary outcomes.ResultsWe included 120 533 facility deliveries, 6503 near misses and 202 maternal deaths in study districts during study period (November 2014 to January 2017). A significant reduction of PPH near misses was found among women who suffered PPH in the intervention district compared with comparison districts (difference-in-differences of slopes −5.3, 95% CI −7.8 to −2.7, p<0.001) from a baseline PPH-related near miss rate of 71% (95% CI 60% to 80%). There was a significant decrease in the long-term PPH near miss case fatality (difference-in-differences of slopes −4 to 0) (95% CI −6.5 to −1.5, p<0.01) in intervention compared with the comparison districts. The intervention had a positive effect on the proportion of PPH cases treated with intravenous oxytocin (difference-in-differences of slopes 5.2, 95% CI 1.4 to 8.9) (p <0.01).ConclusionThe positive effect of the training intervention on PPH morbidity and case fatality suggests that the training addresses important deficits in knowledge and skills.Trial registration numberPACTR201604001582128.

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Section: Discussionmentioning

confidence: 51%

Effect of the competency-basedHelping Mothers Survive Bleeding after Birth(HMS BAB) training on maternal morbidity: a cluster-randomised trial in 20 districts in Tanzania

et al. 2019

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“… 14 PRONTO training focusing on intrapartum and immediate neonatal care improved use of evidence-based practices and decreased neonatal mortality in India and Mexico. 17 , 18 Lastly, quality improvement collaboratives alone do not affect patient outcomes consistently, but are effective in concert with provider training. 19 …”

Section: Introductionmentioning

confidence: 99%

Effect of a quality improvement package for intrapartum and immediate newborn care on fresh stillbirth and neonatal mortality among preterm and low-birthweight babies in Kenya and Uganda: a cluster-randomised facility-based trial

Walker

Otieno

Butrick

et al. 2020

The Lancet Global Health

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Summary Background Although gains in newborn survival have been achieved in many low-income and middle-income countries, reductions in stillbirth and neonatal mortality have been slow. Prematurity complications are a major driver of stillbirth and neonatal mortality. We aimed to assess the effect of a quality improvement package for intrapartum and immediate newborn care on stillbirth and preterm neonatal survival in Kenya and Uganda, where evidence-based practices are often underutilised. Methods This unblinded cluster-randomised controlled trial was done in western Kenya and eastern Uganda at facilities that provide 24-h maternity care with at least 200 births per year. The study assessed outcomes of low-birthweight and preterm babies. Eligible facilities were pair-matched and randomly assigned (1:1) into either the intervention group or the control group. All facilities received maternity register data strengthening and a modified WHO Safe Childbirth Checklist; facilities in the intervention group additionally received provider mentoring using PRONTO simulation and team training as well as quality improvement collaboratives. Liveborn or fresh stillborn babies who weighed between 1000 g and 2500 g, or less than 3000 g with a recorded gestational age of less than 37 weeks, were included in the analysis. We abstracted data from maternity registers for maternal and birth outcomes. Follow-up was done by phone or in person to identify the status of the infant at 28 days. The primary outcome was fresh stillbirth and 28-day neonatal mortality. This trial is registered with ClinicalTrials.gov , NCT03112018 . Findings Between Oct 1, 2016, and April 30, 2019, 20 facilities were randomly assigned to either the intervention group (n=10) or the control group (n=10). Among 5343 eligible babies in these facilities, we assessed outcomes of 2938 newborn and fresh stillborn babies (1447 in the intervention and 1491 in the control group). 347 (23%) of 1491 infants in the control group were stillborn or died in the neonatal period compared with 221 (15%) of 1447 infants in the intervention group at 28 days (odds ratio 0·66, 95% CI 0·54–0·81). No harm or adverse effects were found. Interpretation Fresh stillbirth and neonatal mortality among low-birthweight and preterm babies can be decreased using a package of interventions that reinforces evidence-based practices and invests in health system strengthening. Funding Bill & Melinda Gates Foundation.

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“…Studies in low-resource settings have used SPs to evaluate quality of health service delivery [ 20 , 24 – 26 ], but there are few examples of SP training interventions. Emerging evidence suggests that this methodology not only improves service delivery, but can also improve patient outcomes [ 27 , 28 ]. Given the success of SP programs in other settings, it is plausible that high-quality, patient-centered approaches could fill this “know-do gap” in quality, and increase retention in care among HIV-positive AYA.…”

Section: Introductionmentioning

confidence: 99%

Simulated patient encounters to improve adolescent retention in HIV care in Kenya: study protocol of a stepped-wedge randomized controlled trial

Wilson

Mugo

Bukusi

et al. 2017

Trials

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BackgroundAdolescent-friendly policies aim to tailor HIV services for adolescents and young adults aged 10–24 years (AYA) to promote health outcomes and improve retention in HIV care and treatment. However, few interventions focus on improving healthcare worker (HCW) competencies and skills for provision of high-quality adolescent care. Standardized patients (SPs) are trained actors who work with HCWs in mock clinical encounters to improve clinical assessment, communication, and empathy skills. This stepped-wedge randomized controlled trial will evaluate a clinical training intervention utilizing SPs to improve HCW skills in caring for HIV-positive AYA, resulting in increased retention in care.Methods/designThe trial will utilize a stepped-wedge design to evaluate a training intervention using SPs to train HCWs in assessment, communication, and empathy skills for AYA HIV care. We will recruit 24 clinics in Kenya with an active electronic medical record (EMR) system and at least 40 adolescents enrolled in HIV care per site. Stratified randomization by county will be used to assign clinics to one of four waves – time periods when they receive the intervention – with each wave including six clinics. From each clinic, up to 10 HCWs will participate in the training intervention. SP training includes didactic sessions in adolescent health, current guidelines, communication skills, and motivational interviewing techniques. HCW participants will rotate through seven standardized SP scenarios, followed by SP feedback, group debriefing, and remote expert evaluation. AYA outcomes will be assessed using routine clinic data. The primary outcome is AYA retention in HIV care, defined as returning for first follow-up visit within 6 months of presenting to care, or returning for a first follow-up visit after re-engagement in care in AYA with a previous history of being lost to follow-up. Secondary outcomes include HCW competency scores, AYA satisfaction with care, and AYA clinical outcomes including CD4 and viral load. Additional analyses will determine cost-effectiveness of the intervention.DiscussionThis trial will contribute valuable information to HIV programs in Kenya and other low-resource settings, providing a potentially scalable strategy to improve quality of care and retention in critical HIV services in this population.Trial registrationClinicalTrials.gov, ID: NCT02928900. Registered 26 August 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2266-z) contains supplementary material, which is available to authorized users.

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Impact Evaluation of PRONTO Mexico

Abstract: Supplemental digital content is available in the text.

Cited by 71 publications

References 26 publications

Effect of the competency-basedHelping Mothers Survive Bleeding after Birth(HMS BAB) training on maternal morbidity: a cluster-randomised trial in 20 districts in Tanzania

Effect of the competency-basedHelping Mothers Survive Bleeding after Birth(HMS BAB) training on maternal morbidity: a cluster-randomised trial in 20 districts in Tanzania

Effect of a quality improvement package for intrapartum and immediate newborn care on fresh stillbirth and neonatal mortality among preterm and low-birthweight babies in Kenya and Uganda: a cluster-randomised facility-based trial

Simulated patient encounters to improve adolescent retention in HIV care in Kenya: study protocol of a stepped-wedge randomized controlled trial

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