Maternal and perinatal deaths remain high in low- and middle income countries (LMICs), and continue to be a priority. Despite marked improvements in access to care, quality of care remains suboptimal, partly because of persistent (human) resource shortages. Increasingly, risk-based medicine is employed to address the resource problem and improve outcomes. It facilitates patient triage and provision of quality care to the right person at the right moment. Since few risk prediction models have been developed and implemented in LMICs, it is crucial to investigate how risk prediction models can be successfully implemented as a quality improvement strategy.
To address the major challenges described above, this project will develop, implement and evaluate a risk-based decision-making tool for women in Ghana suffering from hypertensive disorders in pregnancy (HDP). This is an excellent case as uncertainty about the optimal management for severe pre-eclampsia remote from term, especially in the context of shared decision making and respectful care, requires better tools and contextualized evidence to guide clinical decision-making.
We will use an interdisciplinary, mixed-method intervention design consisting of three phases: (1) pre-implementation phase to develop the SPOT tool to improve clinical care, facilitate shared decision making and respectful care (800 women cohort), (2) implementation of the SPOT tool in six hospitals in to a second prospective cohort(800 women), and (3) post-implementation phase to evaluate the impact of the SPOT tool.
The project hence has two major outcomes:
1. A best practice guide to enable effective implementation of health care improvement strategies in low research settings based on risk prediction scores, which facilitate both improved provision of care and experience of care.
2. Practical guidance for the development and implementation of prediction-based decisions-making tools based on shared-decision making principles and the WHO’s quality care framework.
