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CONFERENCE PROCEEDING
Does the Tommy’s Pathway: Clinical decision support tool have the potential to reduce disparities in UK maternity care? Findings from an early adopter implementation evaluation
1
King's College London, Department of Women and Children's Health, LONDON, United Kingdom
2
Royal College of Obstetricians and Gynaecologists, Tommy's National Centre for Maternity Improvement, London, United Kingdom
Eur J Midwifery 2026;10(Supplement 1):A469
ABSTRACT
BACKGROUND:
Tommy’s Clinical Decision Support Tool is a web-based application for assessment of risk of preterm birth and placental dysfunction. It offers more accurate assessment than traditional checklist methods, and instantaneous decision support. Its use could increase the number of women enrolled onto the right care pathway and reduce the number who have their pregnancy medicalised. Ultimately reducing variation in care seen in those from ethnic minority and socially deprived groups that contributes to higher rates of preterm birth and stillbirth.
OBJECTIVES:
We evaluated implementation of the Tool in five early-adopter NHS hospitals to inform a cluster randomised controlled trial (RCT).
METHODS:
We used online surveys, semi-structured interviews and focus groups to investigate: maternity service user and HCP experience; implementation barriers and facilitators; reach, fidelity and unintended consequences. The NASSS framework (Non-adoption or Abandonment of technology by individuals and difficulties achieving Scale-up, Spread and Sustainability) informed design and analysis.
RESULTS:
1181 women and 112 HCPs participated, completing 1260 online surveys, 8 focus groups and 29 semi-structured interviews. Findings highlighted the importance of ensuring the Tool was used in routine care management for all eligible service users. This informed development of additional functionality to allow HCPs to register service users who were unable to sign up themselves. Before this feature was introduced the proportion of service users registered on the Tool, was ~70%, compared to ~90% afterwards. Proportions of women from Asian and Black ethnic groups, and those from the most deprived areas (IMD quintiles 1 & 2), also increased after the change, from 14.6%, 5.8% and 40.9% (of all maternity service users), to 16.9%, 14.2% and 52.4%, respectively.
CONCLUSIONS:
The Tommy’s Tool has the potential to reduce variation in care and ultimately improve outcomes.
KEY MESSAGE:
Findings have been used to optimise the Tool and its implementation strategy to improve acceptability, fidelity and reach in the RCT. Poster session 1 (Group A)
Tommy’s Clinical Decision Support Tool is a web-based application for assessment of risk of preterm birth and placental dysfunction. It offers more accurate assessment than traditional checklist methods, and instantaneous decision support. Its use could increase the number of women enrolled onto the right care pathway and reduce the number who have their pregnancy medicalised. Ultimately reducing variation in care seen in those from ethnic minority and socially deprived groups that contributes to higher rates of preterm birth and stillbirth.
OBJECTIVES:
We evaluated implementation of the Tool in five early-adopter NHS hospitals to inform a cluster randomised controlled trial (RCT).
METHODS:
We used online surveys, semi-structured interviews and focus groups to investigate: maternity service user and HCP experience; implementation barriers and facilitators; reach, fidelity and unintended consequences. The NASSS framework (Non-adoption or Abandonment of technology by individuals and difficulties achieving Scale-up, Spread and Sustainability) informed design and analysis.
RESULTS:
1181 women and 112 HCPs participated, completing 1260 online surveys, 8 focus groups and 29 semi-structured interviews. Findings highlighted the importance of ensuring the Tool was used in routine care management for all eligible service users. This informed development of additional functionality to allow HCPs to register service users who were unable to sign up themselves. Before this feature was introduced the proportion of service users registered on the Tool, was ~70%, compared to ~90% afterwards. Proportions of women from Asian and Black ethnic groups, and those from the most deprived areas (IMD quintiles 1 & 2), also increased after the change, from 14.6%, 5.8% and 40.9% (of all maternity service users), to 16.9%, 14.2% and 52.4%, respectively.
CONCLUSIONS:
The Tommy’s Tool has the potential to reduce variation in care and ultimately improve outcomes.
KEY MESSAGE:
Findings have been used to optimise the Tool and its implementation strategy to improve acceptability, fidelity and reach in the RCT. Poster session 1 (Group A)
| eISSN: | 2585-2906 |
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