Abstract
The 2010 Centers for Disease Control and Prevention (CDC) update on perinatal group B streptococcal (GBS) prevention advises universal vaginal-rectal GBS screening of pregnant women in the 35th through 37th week of gestation. Because GBS colonization is transient, a test performed more than 5 weeks before delivery may not have sufficient negative predictive value to be clinically useful. Our objective was to increase rates of quality-improved, CDC-adherent GBS screening and decrease repeat screening. A reminder for maternal vaginal-rectal GBS testing was added to the physicians' electronic ordering screen, and family medicine physicians and residents were educated about screening guidelines through standardized, in-person presentations. Retrospective chart review was performed before and after these interventions. Univariate or bivariate analysis was performed for demographic factors, timing of first screen, rates of CDC-adherent screening (the newly defined quality-improved screen and the usual screen), and rates of repeat and unnecessary screens. Multivariate analysis was performed with quality-improved and usual screening as dependent variables. Bivariate analysis showed that post-intervention rates of quality-improved screening increased from 30 to 62 % (P <.001), usual screening increased from 69 to 84 % (P =.005), and repeat GBS screening decreased from 20 to 8 % (P =.007). Multivariate analysis showed increased post-intervention odds of quality-improved screening [odds ratio (OR) 3.59; 95 % CI 2.07-6.34] and usual screening (OR 2.67; 95 % CI 1.40-5.25). Low-cost, reproducible quality improvement interventions (electronic order reminder, educational sessions) have the potential to increase guideline adherence for GBS screening in pregnant women and decrease repeat screening.
Original language | English (US) |
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Pages (from-to) | 16-21 |
Number of pages | 6 |
Journal | Maternal and Child Health Journal |
Volume | 18 |
Issue number | 1 |
DOIs | |
State | Published - Jan 2014 |
Keywords
- Group B streptococcal disease
- Guideline compliance
- Prenatal screening
- Quality improvement
ASJC Scopus subject areas
- Epidemiology
- Pediatrics, Perinatology, and Child Health
- Obstetrics and Gynecology
- Public Health, Environmental and Occupational Health