Background
Term | Working definition |
---|---|
eRegistries | Electronic registries (eRegistries) are systems using information and communication technologies for the systematic longitudinal collection, storage, retrieval, analysis, and dissemination of uniform information on health determinants and outcomes of individual persons, to serve healthcare services, health surveillance, health education, knowledge, and research [10]. |
Interactive checklists | Interactive checklists are checklists delivered on electronic platforms. eRegistry’s interactive checklists integrate individualized decision support for daily clinical procedures, diagnosis, management, and referral routines in response to systematic point-of-care data entry by healthcare providers [10]. |
Clinical decision support system | An electronic system designed to aid directly in clinical decision making, in which characteristics of individual patients are used to generate case-specific assessments or recommendations that are then presented to clinicians for consideration [33]. |
Palestinian context
Objectives
Primary objectives
Secondary objectives
Methods
Trial design
Study setting
Eligibility criteria
Intervention
Intervention tool
Adherence
Concomitant care
Outcomes
Process (adherence) outcomes | Source of data | Measurement sequence | Definitions |
---|---|---|---|
Timely and appropriate screening and management of anemia during pregnancy | Case records data from the PHC in the eRegistry | Registrations continuously at point of care, data export to the trial monthly | Proportion of women attending ANC who receive: 1. anemia screening at booking, and 2. screening at any ANC visits at 24 and 36 weeks if no anemia detected, and 3. rescreening after 1 month if mild or moderate anemia is detected, and 4. referred to high-risk clinic if refractory mild or moderate anemia is detected, and 5. referred to hospital if severe anemia is detected. |
Timely and appropriate screening and management of hypertension in pregnancy | Case records data from the PHC in the eRegistry | Registrations continuously at point of care, data export to the trial monthly | Proportion of women attending ANC who receive: 1. blood pressure measurement at booking visit, and 2. blood pressure measurement at every ANC visit, and 3. appropriate laboratory tests for mild hypertension, and 4. referred to high-risk clinic hospital for chronic or gestational hypertension, and 5. referred to hospital for hypertension with proteinuria or signs of eclampsia. |
Timely and appropriate screening and management of abnormal fetal growth | Case records data from the PHC in the eRegistry | Registrations continuously at point of care, data export to the trial monthly | Proportion of women attending ANC who receive: 1. first fundal height measurement at 16–20 weeks, and 2. fetal growth monitoring at every ANC visit, and 3. referred to ultrasound if discrepancy between fundal height and gestational age, and 4. referred to high-risk clinic if ultrasound confirmed fetal growth restriction. |
Timely and appropriate screening and management of diabetes in pregnancy | Case records data from the PHC in the eRegistry | Registrations continuously at point of care, data export to the trial monthly | Proportion of women attending ANC who receive: 1. diabetes screening at booking, and 2. screening with random blood sugar test at 24–28 weeks, and 3. referred to high-risk clinic if random blood sugar test or glucose challenge test ≥ 140 mg/dl. |
Adverse pregnancy outcomes | Source of data | Measurement sequence | Definitions |
---|---|---|---|
Moderate or severe anemia at admission for labor | Hemoglobin admission data from hospitals in the eRegistry (public, private, and NGO hospitals) | Registrations continuously at point of care, data export to the trial monthly | Moderate anemia: hemoglobin greater than 7 and less than 9 g/dl; severe anemia: hemoglobin < 7 g/dl |
Severe hypertension at admission for labor | Blood pressure admission data from hospitals (public, private, and NGO hospitals) in the eRegistry | Registrations continuously at point of care, data export to the trial monthly | Severe hypertension: systolic blood pressure ≥ 160 mmHg and/ or diastolic blood pressure ≥ 110 mmHg |
Malpresentation at delivery undetected during pregnancy | Presentation at delivery data from hospitals (public, private, and NGO hospitals) in MCH registry | Registrations continuously at point of care, data export to the trial monthly | All non-cephalic presentations at or after 36 weeks of gestation and at labor |
Small-for-gestational age baby at delivery undetected during pregnancy | Birth weight data from hospitals (public, private, and NGO hospitals) in the eRegistry | Registrations continuously at point of care, data export to the trial monthly | Small for gestational age: less than 2549 g [34] |
Large for gestational age baby at delivery | Birth weight data from hospitals (public, private, and NGO hospitals) in the eRegistry | Registrations continuously at point of care, data export to the trial monthly | Large for gestational age: greater than 3980 g [34] |
Secondary outcomes | Source of data | Measurement sequence | Definitions |
---|---|---|---|
Timely ANC visits | Case records data from the PHC in the eRegistry | Registrations continuously at point of care, data export to the trial monthly | Proportion of women attending ANC who receive timely ANC visits according to guidelines at: 1. booking visit 2. 16 weeks gestation 3. 18–22 weeks gestation 4. 24–28 weeks gestation 5. 32 weeks gestation 6. 36 weeks gestation |
Timely and appropriate screening and management of malpresentation ≥ 36 weeks | Case records data from the PHC in the eRegistry | Registrations continuously at point of care, data export to the trial monthly | Proportion of women attending ANC who receive: 1. screening for fetal presentation at any visit ≥ 36 weeks, and 2. referred to hospital for non-cephalic presentation |
Stillbirth | Stillbirth data from the hospitals (public, private, and NGO hospitals) in the eRegistry | Registrations continuously at point of care, data export to the trial monthly | Baby born with no signs of life at or after 28 weeks of gestation |
Effect on healthcare equity
Timeline
Sample size
Outcome measure | Control group prevalence |
---|---|
Adverse pregnancy outcomes: composite of any of the five conditions below, accounting for coexistence of conditions in 10% of women | 0.145 |
1. Moderate or severe anemia at admission for labor | 0.0225 |
2. Large-for-gestational age baby at delivery | 0.054 |
3. Small-for-gestational age baby at delivery undetected during pregnancy | 0.057 |
4. Malpresentation at delivery undetected during pregnancy | 0.02 |
5. Severe hypertension at admission for labor | 0.01 |
Process (adherence) outcomes | 0.40–0.60 |