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Table 4 Indicators for the final evaluation of a health systems intervention to improve care during and after a pregnancy complicated by diabetes

From: Improving systems of care during and after a pregnancy complicated by hyperglycaemia: A protocol for a complex health systems intervention

Objective Final evaluation question addressed* Indicator Data source Data collection
REACH
 Increase (FNQ) and sustain (NT) engagement of clinicians with the project 3 Health practitioner awareness of Partnership and activities Health professionals Interviews
3 Health practitioner attendance at Partnership education events Project activity log Surveys
3 Use of project online health professional educational resources Website Activity log
Metrics from website
 Improve health practitioner awareness of DIP Clinical Register 3 Health practitioner awareness of DIP Clinical Register Health professionals
DIP Clinical Register
Interviews
Surveys
 Increase (FNQ) and sustain (NT) coverage of the DIP Clinical Register 1 DIP Clinical Register coverage; trajectory of coverage over time Comparison of DIP Clinical Register with health service data Health service reports
 Determine the number and characteristics of women accessing and not accessing antenatal care   Number of women accessing antenatal care, including number and timing of visits Health service electronic health records
DIP Clinical Register
Health service reports1
Audit
EFFECTIVENESS
 Enhance support for health practitioners 1 Health practitioner perception of support Health professionals Interviews
4 Health practitioner and champion reports of which activities have been useful in enhancing support Champions Surveys
 Increase health practitioner awareness of and confidence in managing hyperglycaemia in pregnancy 1 Health practitioners perceived knowledge and confidence, and changes from Partnership formative work Health professionals
Health service electronic health records
Interviews
Surveys
1 Rates of completion of recommended glucose screening in early pregnancy for high risk women DIP Clinical Register
Formative DIP Models of Care work
Audit
 Earlier hyperglycaemia in pregnancy screening women at high risk 1 Rates of completion of recommended early pregnancy screening for high risk women DIP Clinical Register Audit
 Improved blood glucose levels for women with diabetes in pregnancy 2 Mean first- and third-trimester HbA1c and changes over time DIP Clinical Register Audit
 Improved birth and neonatal outcomes 2 Gestational age at delivery
Mode of delivery
Birth weight
Large for gestational age
Small for gestational age
Macrosomia
Neonatal obstetric trauma
Neonatal hypoglycaemia requiring treatment
Neonatal special care admission
5-minute APGAR score less than 5
Neonatal jaundice requiring treatment
Neonatal respiratory distress
DIP Clinical Register Audit
 Improve health practitioners’ awareness of postpartum guidelines 1 Health practitioner awareness of guidelines and changes over time Health professionals
Champions
Interviews
Surveys
 Improve postpartum management, according to guidelines, following diabetes in pregnancy 2 Proportion of women completing postpartum glucose testing
Postpartum weight, body mass index, waist circumference
Proportion of women breastfeeding
Proportion of women smoking
Proportion of women prescribed contraception, or who have discussed contraception with a health practitioner
Changes over time in all indicators
Electronic health records
DIP Clinical Register
Audit
 Enhance communication between primary healthcare and hospital services 1 Health practitioner perception of communication between primary healthcare and hospital services Health professionals Interviews
3 Health practitioner and champion reports of which activities have contributed to changes Champions Surveys
 Improve referral pathways and care coordination for services caring for women with hyperglycaemia in pregnancy 1 Health practitioner knowledge of referral pathways Health professionals Interviews
1 Health practitioner perception of improvements in care coordination Champions Surveys
3 Health practitioner and champion reports of which activities have contributed to changes
 Improve discharge processes 1 Health practitioner perception of usefulness of discharge summaries Health professionals Interviews
1 Health practitioner and champion perception of impact of discharge processes on postpartum care Champions Surveys
ADOPTION
 Enhance referrals to DIP Clinical Register 1 DIP Clinical Register coverage Comparison of DIP Clinical Register with health service data
Health professionals
Health service reports1
Interviews
Surveys
3 Health service perceptions of referral process
 Improve practitioner use of DIP Clinical Register 1 Health practitioner use of DIP Clinical Register and reports Health professionals Interviews
3 Health practitioner reports of which aspects of reports are useful in practice DIP Clinical Register Surveys
External use of DIP Clinical Register website, e.g. website metrics
 Identify enablers and barriers impacting on adoption of project activities 3 Health practitioner, implementer and champion reports of enablers and barriers Health professionals
Implementers
Champions
Interviews
 Determine acceptability and value of project activities
  •Are project activities socially appropriate/ acceptable?
  •What is the social importance of project outcomes?
  •Which project activities are perceived as valuable?
4 Health practitioner, implementer and champion perceptions of acceptability and value of project activities Health professionals
Implementers
Champions
Women
Interviews
IMPLEMENTATION
 Determine if project activities have been delivered as intended 3 Proportion of planned activities delivered Project activity log
Implementers
Interviews
Audit of activity log
 Determine if project activities have been adapted, e.g. to fit local needs 3 Adaptations of planned activities and rationale Implementers Interviews
 Identify enablers and barriers impacting on implementation of project activities 3 Enablers and barriers as identified by implementation team Implementers
Health professionals
Champions
Interviews
MAINTENANCE
 Sustain DIP Clinical Register through integration with other structures 5 Health practitioners and services perceptions of sustainability of the DIP Clinical Register
Resources required and cost of maintaining DIP Clinical Register
Health professionals
Champions
Implementers
Activity log
Interviews
Surveys
Cost-consequences analysis
 Identify project activities sustainable beyond project completion, and method for funding or integration into existing services 5 Health professional, champion and implementer perception of sustainability of project activities
Resources required for project activity sustainability
Health professionals
Champions
Implementers
Activity log
Interviews
Cost-consequences analysis
  1. *Evaluation questions: 1. To what degree has the health systems intervention improved systems of care during and after a pregnancy complicated by hyperglycaemia?; 2. To what degree has the health systems intervention improved maternal and neonatal outcomes during and after a pregnancy complicated by hyperglycaemia?; 3. If improvements are demonstrated, which activities of the health systems intervention have contributed to this improvement, and what enablers and barriers have impacted on the success of these activities?; 4. Are activities considered socially valid by healthcare providers, champions and stakeholders?; 5. How do the resources required for project activities balance against the benefits?; 6. How can the Partnership support the continuation of successful project activities after completion of the health systems intervention?
  2. Abbreviations: NT Northern Territory, FNQ Far North Queensland
  3. 1NT Midwives’ Data Collection, FNQ Queensland Health Case Mix reports