Impact of Implementation Tools for Spontaneous Preterm Birth Guidelines: A Systematic Review and Meta-Analysis.

Abstract

Preterm birth is a priority area for practice improvement internationally. Clinical practice guidelines improve the efficiency of clinical decision-making and, when implemented effectively, may advance the quality and consistency of care. Guideline implementation tools may help to further optimise the use of guidelines. To determine if guideline implementation tools improve adherence to preterm birth guideline recommendations and have an impact on differences seen by ethnicity. Systematic search of MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials and Scopus on 11 December 2023. Eligibility criteria included randomised and non-randomised studies that used an implementation tool and measured adherence to a guideline on preterm birth. Data were extracted including study details and ethnicity as an equity consideration. Meta-analyses were performed on adherence to preterm birth guideline recommendations with planned subgroup analysis by ethnicity/Indigeneity and topic of guideline. Twenty studies were included; two cluster randomised controlled trials and 18 before-after studies. Nineteen studies comparing guideline implementation tool to no tool reported improved adherence to guideline recommendations with the use of a tool (data for meta-analysis from 14 studies, 20 961 people, OR 13.8, 95% CI 6.02-31.71, adherence in 3871/11 195 [34.6%] before compared with 6607/9766 [67.6%] after). Only one study performed analysis by ethnicity. Effective implementation tools have the potential to increase adherence to evidence-based preterm birth guidelines, improving quality and consistency of preterm birth care.