 |
|
Methods to Encourage the Use of Antenatal Corticosteroid Therapy for Fetal Maturation
A Randomized Controlled Trial
Laura C. Leviton, PhD;
Robert L. Goldenberg, MD;
C. Suzanne Baker, RN, MPH;
Rachel M. Schwartz, MPH;
Margaret C. Freda, EdD, RN;
Larry J. Fish, PhD;
Suzanne P. Cliver;
Dwight J. Rouse, MD;
Cynthia Chazotte, MD;
Irwin R. Merkatz, MD;
James M. Raczynski, PhD
JAMA. 1999;281:46-52.
Context Antenatal corticosteroids for fetal maturation have been underused, despite evidence for their benefits in cases of preterm birth.
Objective To evaluate dissemination strategies aimed at increasing appropriate use of this therapy.
Design and Setting Twenty-seven tertiary care institutions were randomly assigned to either usual dissemination of practice recommendations (n=14) or usual dissemination plus an active, focused dissemination effort (n=13).
Subjects Obstetricians and their preterm delivery cases at participating hospitals.
Intervention Recommendations by a National Institutes of Health (NIH) Consensus Conference held in late February–early March 1994 were disseminated in early May 1994. Usual dissemination was publication of the recommendations and endorsement by the American College of Obstetricians and Gynecologists. Active dissemination was a year-long educational effort led by an influential physician and a nurse coordinator at each facility, consisting of grand rounds, a chart reminder system, group discussion of case scenarios, monitoring, and feedback.
Main Outcome Measure Use or nonuse of antenatal corticosteroids was abstracted from medical records of eligible women delivering at the participating hospitals in the 12 months immediately prior to release of the NIH recommendations (average number of records abstracted, 130) and in the 12 months following their release (average number of records abstracted, 122).
Results Active dissemination significantly increased the odds of corticosteroid use after the conference. Use increased from 33.0% of eligible patients receiving corticosteroids to 57.6%, or by 75% over baseline, in usual dissemination hospitals. Use increased from 32.9% to 68.3%, or an 108% increase, in active dissemination hospitals. Gestational age and maternal diagnosis affected use of the therapy in complex ways.
Conclusion An active, focused dissemination effort increased the effectiveness of usual dissemination methods when combined with key principles to change physician practices.
Author Affiliations: Department of Health Behavior, School of Public Health (Drs Leviton, Fish, and Raczynski) and Department of Obstetrics and Gynecology, School of Medicine (Drs Goldenberg and Rouse and Mss Baker and Cliver), University of Alabama at Birmingham; National Perinatal Information Center, Providence, RI (Ms Schwartz); and Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine of Yeshiva University, New York, NY (Drs Freda, Chazotte, and Merkatz).
RELATED ARTICLE
January 6, 1999
JAMA. 1999;281(1):101-102.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
A Behavioral Intervention to Improve Obstetrical Care
Althabe et al.
NEJM 2008;358:1929-1940.
ABSTRACT
| FULL TEXT
Black/White Differences in Very Low Birth Weight Neonatal Mortality Rates Among New York City Hospitals
Howell et al.
Pediatrics 2008;121:e407-e415.
ABSTRACT
| FULL TEXT
Evidence-Based Strategies for Implementing Guidelines in Obstetrics: A Systematic Review.
Chaillet et al.
Obstet Gynecol 2006;108:1234-1245.
ABSTRACT
| FULL TEXT
Acute and Long-Term Effects of Clinical Doses of Antenatal Glucocorticoids in the Developing Fetal Sheep Kidney
Massmann et al.
Reproductive Sciences 2006;13:174-180.
ABSTRACT
Cluster Randomized Trials for the Evaluation of Strategies Designed to Promote Evidence-Based Practice in Perinatal and Neonatal Medicine
Leviton and Horbar
The ANNALS of the American Academy of Political and Social Science 2005;599:94-114.
ABSTRACT
Evidence based care
Brocklehurst and McGuire
BMJ 2005;330:36-38.
FULL TEXT
Changes in Mortality for Extremely Low Birth Weight Infants in the 1990s: Implications for Treatment Decisions and Resource Use
Meadow et al.
Pediatrics 2004;113:1223-1229.
ABSTRACT
| FULL TEXT
Organizing Regional Perinatal Quality Improvement: Global Considerations and Local Implementation
Wirtschafter and Powers
NeoReviews 2004;5:e50-59.
FULL TEXT
Estimating the Effects of Interventions That are Deployed in Many Places: Place-Randomized Trials
Boruch et al.
American Behavioral Scientist 2004;47:608-633.
ABSTRACT
Evaluation Use: Advances, Challenges and Applications
Leviton
American Journal of Evaluation 2003;24:525-535.
Explanations for Improvement in Both Experimental and Control Groups
Becker et al.
West J Nurs Res 2003;25:746-755.
ABSTRACT
Statistics, Not Memories: What Was the Standard of Care for Administering Antenatal Steroids to Women in Preterm Labor Between 1985 and 2000?
Meadow et al.
Obstet Gynecol 2003;102:356-362.
ABSTRACT
| FULL TEXT
Variations in Antenatal Corticosteroid Therapy: A Persistent Problem Despite 30 Years of Evidence
Chien et al.
Obstet Gynecol 2002;99:401-408.
ABSTRACT
| FULL TEXT
Antenatal Corticosteroids and Newborn Screening for Congenital Adrenal Hyperplasia
King et al.
Arch Pediatr Adolesc Med 2001;155:1038-1042.
ABSTRACT
| FULL TEXT
REPEATED COURSES OF ANTENATAL CORTICOSTEROIDS
Goldenberg and Wright
Obstet Gynecol 2001;97:316-317.
ABSTRACT
| FULL TEXT
Obstetrician-Gynecologists' Knowledge and Training About Antenatal Corticosteroids
ERICKSON et al.
Obstet Gynecol 2001;97:140-146.
ABSTRACT
| FULL TEXT
Transforming Insurance Coverage Into Quality Health Care: Voltage Drops From Potential to Delivered Quality
Eisenberg and Power
JAMA 2000;284:2100-2107.
ABSTRACT
| FULL TEXT
Antenatal corticosteroids to prevent neonatal respiratory distress syndrome
Spencer and Neales
BMJ 2000;320:325-326.
FULL TEXT
|
