TowaRds implEmentATion of phototherapy for neonatal jaundice at home – TREAT Jaundice @ home study

BACKGROUND Neonatal jaundice is a common phenomenon and one of the major causes of hospital (re)admission in the neonatal period. One in twenty healthy newborns requires phototherapy treatment for jaundice, which is typically applied in-hospital, where mother and child cannot always stay together. Evidence suggests that phototherapy (PT) can be applied at home safely and effectively in the vast majority of jaundiced newborns. Building on experiences from applying phototherapy in primary care from the STARSHIP trial and from few early adopter hospitals we will explore determinants for successful implementation of PT at home. Based on this we will develop a tailored implementation strategy which will be piloted in two regions and subsequently finalised into a protocol for national upscaling of PT at home. AIM The overall aim of this research proposal is to implement of PT at home in obstetric care networks (OCNs), using a tailored strategy according to the phases of the Consolidated Framework for Implementation Research (CFIR). SETTING The study will be performed in six OCNs of the Regional Consortium Pregnancy and Childbirth Southwest and Northern Netherlands. At the end of the study an implementation strategy will be nationally available. METHODS The study consists of 3 workstreams (WS) WS 1: POTENTIAL BARRIERS AND FACILITATORS RQ1a: What are the lessons learnt from Dutch paediatric wards who already have implemented PT at home? We will explore with healthcare professionals (HCPs) who already provide PT at home lessons learnt about: e.g. optimal eligibility assessment for safe application of PT at home (based on medical and social context), organisation of practical tasks, primary responsibility for the newborn, and financial arrangements for hospitals that provide PT at home. RQ1b: What are the potential determinants (e.g., barriers and facilitators) for successful implementation of PT at home? Focus group interviews with HCPs of OCNs e.g. midwives, paediatricians, maternity care assistants, management, healthcare buyers and insurance companies, as well as individual semi-structured interviews with parents will be performed, based on the CFIR domains. Based on the interview results we will survey the importance of the identified barriers and facilitators. WS 2: DEVELOPMENT OF TAILORED IMPLEMENTATION STRATEGY RQ 2: What should be the content of a tailored implementation strategy and the appropriate method of delivery and operationalisation of the different elements of the strategy? The tailored implementation strategy will be developed in six steps: 1) Thoroughly analysing implementation factors; 2) Linking implementation factors to theoretical constructs; 3) Considering useful theories and associated strategies; 4) Inventorying evidence for implementation strategies; 5) Selecting core strategies; 6) Arriving at a practical plan for implementation. Steps 5 and 6 will be done in collaboration with parents, HCPs and management of maternity care organisations during focussed development sessions. This will ensure appropriate strategies and tailoring to the context. To allow the OCNs to work with this implementation strategy (toolkit) during the study and afterwards, they will supervised by an implementation expert. WS 3: ASSESSMENT OF TAILORED IMPLEMENTATION STRATEGY RQ3a: To what extent will the tailored implementation strategy lead to adherence of PT at home in newborns with jaundice? RQ3b: To what extent does the set of tailored implementation strategies lead to change in patient outcomes and parental experiences related to home PT? *Design: the process of implementation of PT at home and its adherence will be studied in a prospective before-after study. *Implementation home PT: This consists of implementation of home PT using elements of the tailored implementation strategy (see WS 2). The OCN teams (n=6) will be responsible for implementation of home PT according the following process steps: a) defining target goals for implementation of home PT; b) planning and acting by using the tailored implementation strategy; c) evaluating by measuring their target goals. *Outcomes: ** Primary: -Reach of PT at home -Adherence to protocol ** Secondary: -Clinical outcomes: e.g., PT duration, number of blood samples taken to quantify serum bilirubin, complications and failure of PT at home, costs -Parental experience RQ3c: What are the experiences of healthcare professionals and parents with the tailored implementation strategies? The process evaluation will give us insight in elements of the tailored strategy that are less feasible and must be adjusted for further national scaling up. Feasibility will be measured with the NoMAD questionnaire. Further, HCPs and parents will be interviewed to learn about their perceptions of the study effects on local practice and the effects of the implementation strategy. TIME SCHEDULE The project is planned according to the following timeline: WS1: 8 mo; WS2: 6 mo; WS3: 14 mo; report: 2 mo