Alberta Collaborative QI Strategies to Improve Outcomes of Moderate and Late Preterm Infants (ABC-QI Trial)

NCT ID: NCT05231200

Last Updated: 2025-07-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

9500 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-05-01

Study Completion Date

2027-08-30

Brief Summary

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The ABC-QI Trial aims to implement collaborative quality improvement (QI) strategies to standardize care for 32-36 week infants in Level 2 and 3 Neonatal intensive care units (NICUs) across the province of Alberta. The investigators want to know if using validated quality improvement methods and evidence-based care bundles will decrease the duration of hospital stay and get babies home as quickly as possible.

Detailed Description

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A stepped-wedge cluster randomized trial will be conducted in 12 NICUs across Alberta (10 Level II and 2 Level III). Each NICU is considered a cluster and will be randomized to transition to the intervention arm at one of three time points.

The planned trial interventions include:

Intervention arm (Collaborative QI Strategies): The study intervention is a constellation of collaborative QI strategies: 1) QI Team Building; 2) QI Education; 3) Implementation of 2 standardized practice care bundles (Respiratory Care, and Nutritional Care); 4) QI mentoring; and 5) Collaborative networking. Based on the randomization, 4 NICUs will transition to the intervention arm at the end of each year.

Control arm (current management): All participating NICUs will be in the control arm during the first year prior to randomization to create a baseline of the current practices and between-units variation. NICUs in the control arm can continue conducting QI activities relevant to current practice, but without receiving the interventions outlined above.

Conditions

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Length of Stay

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SEQUENTIAL

A stepped-wedge cluster randomized trial (SW-CRT) design. Each of the 12 participating NICUs (10 Level II and 2 Level III) are considered clusters and will be randomized to transition to the intervention arm at one of three-time points over a period of four years. The first year will be a baseline period where no clusters are exposed to the intervention. Based on the randomization, four NICUs will transition to the intervention arm at the end of each year. All clusters will have transitioned to the intervention arm by the start of year four.
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Control Arm- Current management

NICUs in the control arm can continue conducting QI activities relevant to current practice and current standard of care, but without receiving the interventions until they transition to the intervention arm.

Group Type ACTIVE_COMPARATOR

Current practice- standard of care

Intervention Type OTHER

All participating NICUs will be in the control arm during the first year prior to randomization to create a baseline of the current practices and between-units variation. NICUs in the control arm can continue conducting QI activities relevant to current practice, but without receiving the interventions outlined above until they transition to the intervention arm. The investigators will capture these activities and account for them in the analysis.

Intervention Arm- Collaborative Quality implementation Strategies

The study intervention is a constellation of collaborative QI strategies: 1) QI Team Building; 2) QI Education; 3) Implementation of 2 standardized practice care bundles (Respiratory Care, and Nutritional Care); 4) QI mentoring; and 5) Collaborative networking.

Group Type EXPERIMENTAL

QI Team Building

Intervention Type BEHAVIORAL

Each NICU will create a core QI team composed of 6-8 multidisciplinary members including a parent advisor, when feasible. This team will lead the QI activities and education, and champion the culture and practice change in the unit.

QI education

Intervention Type BEHAVIORAL

Each NICU QI team will receive standardized QI education using the 6-hour EPIQ Workshop which involves hands-on approach to enable teams to successfully implement QI projects together. EPIQ 10 Steps and QI Tools will be used to build the team's understanding of QI using realistic improvement opportunities based on the standardized care bundles identified in the trial.

Standardized care bundle- respiratory care

Intervention Type OTHER

A care bundle is a small, simple set (3-5 elements) of evidence-based practices that, when performed collectively and reliably, will result in improved patient outcomes. This bundle will aim to implement best practices for stabilization and respiratory care in moderate and late preterm infants (MLPIs) including

1. establishing effective ventilation in the delivery room
2. prevention of hypothermia
3. early diagnosis and management of respiratory distress with continuous positive airway pressure (CPAP)
4. standardized approach for surfactant indications and administration
5. standardized approach for early extubation.

Standardized care bundle- nutritional care

Intervention Type OTHER

A care bundle is a small, simple set (3-5 elements) of evidence-based practices that, when performed collectively and reliably, will result in improved patient outcomes. This bundle will aim to implement best practices for nutritional support in MLPIs including

1. early initiation of enteral or parenteral nutrition;
2. standardized tables for feeding initiation and progression
3. optimizing breastfeeding and use of mother's own milk
4. standardized approach for a transition from enteral nutrition via tube feeds to oral feeds.

QI mentoring

Intervention Type BEHAVIORAL

Each NICU in the intervention arm will have one or more assigned members of the study team who are experienced in collaborative QI and EPIQ methods. The mentors will help local QI teams to engage frontline staff in QI and navigate the unit-specific challenges.

Collaborative networking

Intervention Type BEHAVIORAL

The study team will conduct virtual meetings every 2 months for the NICUs in intervention arm allowing local QI teams to discuss progress, and share data. The investigators will arrange annual in-person or virtual meetings for the NICUs in the intervention arm to present projects, successes, and lessons learned. These NICUs will have continuing access to the data and will receive quarterly reports using statistical process control charts outlining the unit's performance compared to other units and to the group average.

Interventions

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QI Team Building

Each NICU will create a core QI team composed of 6-8 multidisciplinary members including a parent advisor, when feasible. This team will lead the QI activities and education, and champion the culture and practice change in the unit.

Intervention Type BEHAVIORAL

QI education

Each NICU QI team will receive standardized QI education using the 6-hour EPIQ Workshop which involves hands-on approach to enable teams to successfully implement QI projects together. EPIQ 10 Steps and QI Tools will be used to build the team's understanding of QI using realistic improvement opportunities based on the standardized care bundles identified in the trial.

Intervention Type BEHAVIORAL

Standardized care bundle- respiratory care

A care bundle is a small, simple set (3-5 elements) of evidence-based practices that, when performed collectively and reliably, will result in improved patient outcomes. This bundle will aim to implement best practices for stabilization and respiratory care in moderate and late preterm infants (MLPIs) including

1. establishing effective ventilation in the delivery room
2. prevention of hypothermia
3. early diagnosis and management of respiratory distress with continuous positive airway pressure (CPAP)
4. standardized approach for surfactant indications and administration
5. standardized approach for early extubation.

Intervention Type OTHER

Standardized care bundle- nutritional care

A care bundle is a small, simple set (3-5 elements) of evidence-based practices that, when performed collectively and reliably, will result in improved patient outcomes. This bundle will aim to implement best practices for nutritional support in MLPIs including

1. early initiation of enteral or parenteral nutrition;
2. standardized tables for feeding initiation and progression
3. optimizing breastfeeding and use of mother's own milk
4. standardized approach for a transition from enteral nutrition via tube feeds to oral feeds.

Intervention Type OTHER

QI mentoring

Each NICU in the intervention arm will have one or more assigned members of the study team who are experienced in collaborative QI and EPIQ methods. The mentors will help local QI teams to engage frontline staff in QI and navigate the unit-specific challenges.

Intervention Type BEHAVIORAL

Collaborative networking

The study team will conduct virtual meetings every 2 months for the NICUs in intervention arm allowing local QI teams to discuss progress, and share data. The investigators will arrange annual in-person or virtual meetings for the NICUs in the intervention arm to present projects, successes, and lessons learned. These NICUs will have continuing access to the data and will receive quarterly reports using statistical process control charts outlining the unit's performance compared to other units and to the group average.

Intervention Type BEHAVIORAL

Current practice- standard of care

All participating NICUs will be in the control arm during the first year prior to randomization to create a baseline of the current practices and between-units variation. NICUs in the control arm can continue conducting QI activities relevant to current practice, but without receiving the interventions outlined above until they transition to the intervention arm. The investigators will capture these activities and account for them in the analysis.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

Preterm Infants: Infants born at 32 to 36 weeks' gestation and admitted to the participating NICUs or postpartum units.

Quality Improvement Implementation Survey version 2 (QIIS-II) and semi-structured interview participants: Management staff, nurses, nurse practitioners, physicians, and allied health staff employed in participating NICUs.

Exclusion Criteria

* Preterm Infants:

* Major congenital anomalies or chromosomal abnormalities.
* Primary admission to a surgical NICU: Alberta Children's Hospital or Stollery Children's Hospital.
* Infants born in or transferred to a NICU outside Alberta.
* Patients who have imposed confidentiality restrictions on accessing their health records.
Minimum Eligible Age

32 Weeks

Maximum Eligible Age

36 Weeks

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Alberta

OTHER

Sponsor Role collaborator

Alberta Health services

OTHER

Sponsor Role collaborator

Covenant Health, Canada

OTHER

Sponsor Role collaborator

University of Calgary

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Ayman Abou Mehrem, MD

Role: PRINCIPAL_INVESTIGATOR

University of Calgary

Jennifer Toye, MD

Role: PRINCIPAL_INVESTIGATOR

University of Alberta

Locations

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Peter Lougheed Centre

Calgary, Alberta, Canada

Site Status RECRUITING

Foothills Medical Centre

Calgary, Alberta, Canada

Site Status RECRUITING

Rockyview General Hospital

Calgary, Alberta, Canada

Site Status RECRUITING

South Health Campus

Calgary, Alberta, Canada

Site Status RECRUITING

Grande Prairie Regional Hospital

Calgary, Alberta, Canada

Site Status RECRUITING

Royal Alexandra Hospital

Edmonton, Alberta, Canada

Site Status RECRUITING

Misericordia Community Hospital

Edmonton, Alberta, Canada

Site Status RECRUITING

Grey Nuns Community Hospital

Edmonton, Alberta, Canada

Site Status RECRUITING

Sturgeon Community Hospital

Edmonton, Alberta, Canada

Site Status RECRUITING

Chinook Regional Hospital

Lethbridge, Alberta, Canada

Site Status RECRUITING

Medicine Hat Regional Hospital

Medicine Hat, Alberta, Canada

Site Status RECRUITING

Red Deer Regional Hospital

Red Deer, Alberta, Canada

Site Status RECRUITING

Countries

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Canada

Central Contacts

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Mahesha Bandara, MSc

Role: CONTACT

1-403-944-3753

Ayman Abou Mehrem, MD

Role: CONTACT

1-403-944-3699

Facility Contacts

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Mahesha Bandara, MSc

Role: primary

Mahesha Bandara, MSc

Role: primary

1-403-944-3753

Mahesha Bandara, MSc

Role: primary

Mahesha Bandara, MSc

Role: primary

Mahesha Bandara, MSc

Role: primary

Mahesha Bandara, MSc

Role: primary

Mahesha Bandara, MSc

Role: primary

Mahesha Bandara, MSc

Role: primary

Mahesha Bandara, MSc

Role: primary

Mahesha Bandara, Msc

Role: primary

Mahesha Bandara, MSc

Role: primary

Mahesha Bandara, MSc

Role: primary

References

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Abou Mehrem A, Toye J, Aziz K, Benzies K, Alshaikh B, Johnson D, Faris P, Soraisham A, McNeil D, Al Hamarneh YN, Foss K, Foulston C, Johns C, Zimmermann GL, Zein H, Hendson L, Kumaran K, Price D, Singhal N, Shah PS. Alberta Collaborative Quality Improvement Strategies to Improve Outcomes of Moderate and Late Preterm Infants (ABC-QI) Trial: a protocol for a multicentre, stepped-wedge cluster randomized trial. CMAJ Open. 2023 May 2;11(3):E397-E403. doi: 10.9778/cmajo.20220177. Print 2023 May-Jun.

Reference Type DERIVED
PMID: 37130608 (View on PubMed)

Other Identifiers

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462647

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

21-1336

Identifier Type: -

Identifier Source: org_study_id

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