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101: Barrier analysis: using quality improvement methodology to decrease health disparities in recurrent preterm birth
Oral Concurrent Session 8
CLINICAL OBSTETRICS 2
arterial lactate with nearly comparable predictive ability for neonatal morbidity at term. Umbilical venous lactate may be used as a measure of neonatal morbidity risk when arterial blood is not available.
101 Barrier analysis: using quality improvement methodology to decrease health disparities in recurrent preterm birth Jodi Abbott1, Carolyn Smith-Lin1, Renee O’Toole2, Aviva Lee-Parritz1
ajog.org
interventions to reduce recurrent SPTD 5) Partnered with hospital pharmacy to create financially viable route for 17OHP availability RESULTS: During the course of the project (1/1/2013-2/28/2015) d EHR documentation of SPTD counseling for prevention rose from 0 to 88%. d In eligible patients, the rate of interventions rose from 37% to 89%, a 58% increase, close to goal attainment. d There was a decrease in the rate of recurrent preterm birth from 29% to 8%, a 73% reduction. CONCLUSION: A barrier analysis is effective in creating successful interventions to reduce recurrent preterm birth in an urban safety net hospital. The reduction in preterm birth after consistent use of serial cervical ultrasounds and progesterone yielded a greater rate of reduction in recurrent SPTD than that predicted by published data, in a particularly high risk population. Cost savings are calculated at $65000 per 38 preterm births averted annually, $2.47 million. Interventions that focus on patient education and empowerment are a key component to reducing health disparities preterm birth.
102 RCT of azithromycin-based extended-spectrum antibiotic prophylaxis for cesarean delivery: role of placental colonization with ureaplasma or mycoplasma
OBJECTIVE: 90% of women at Boston Medical Center, the largest
Alan Tita, M.D., Ph.D.1, Ken Waites2, Victoria Jauk1, Joseph Biggio1, Amelia Sutton1, Jeff Szychowski1, John Hauth1, William Andrews1
safety net hospital in New England, with a prior spontaneous preterm delivery (SPTD) will have serial cervical ultrasounds and counseling for progesterone in a subsequent pregnancy by January 2015. STUDY DESIGN: A Barrier Analysis was performed. This revealed 4 major types of barriers: 1) Patients: Women had a lack of awareness of preterm birth or interventions for prevention. Women demonstrated lack of self-advocacy in treatment settings. More than 50% of patient’s primary language is not English. 2)Providers: There are multiple types of prenatal care providers in our community, other than Obstetrician Gynecologists, including Family Medicine physicians, midwives and nurse practitioners. There was a lack of provider awareness of the patient’s history SPTD or interventions to prevent recurrence. 3) Suboptimal use of Electronic Health Record (EHR) 4) Challenges obtaining 17OH progesterone (17OHP) Interventions based on barrier analysis: 1) Tracked the counseling of women with primary SPTD. 2) Standardized counseling and documentation. 3) Created multiple points for patient identification 4) Acted as a key driver to increase community prenatal provider awareness of
OBJECTIVE: The mechanism by which extended spectrum (ES) antibiotic prophylaxis (AP) with azithromycin (AZI) reduces postcesarean (CD) infection by 50% is uncertain. We determined the effects of ES AP on placental colonization with ureaplasmas and mycoplasmas and assessed differential impact on post-CD infections. STUDY DESIGN: The multicenter double-blind C/SOAP RCT (CT.gov NCT01235546), included women 24 wks’ GA who had CD during (labor or at least 4 hrs after membrane rupture) and received standard AP (cefazolin). Subjects were randomized to also receive either AZI (500mg in 250ml saline) or identical placebo (250ml saline) given pre-incision (or as soon as possible after). In a substudy, chorioamnion and placenta specimens from all subjects at a single-center were blindly tested for genital Ureaplasma and Mycoplasma species by culture and real-time PCR. The centrally adjudicated primary outcome for this sub-study was a composite of endometritis, wound infection, or other rare infections (abdominopelvic abscess, sepsis, pelvic septic thrombophlebitis) within 6
1
Boston University School of Medicine, Boston, MA, 2SUNY Downstate, Boston, MA
1
University of Alabama at Birmingham, Center for Women’s Reproductive Health, Birmingham, AL, 2University of Alabama at Birmingham, Birmingham, AL
S70 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2016
CLINICAL OBSTETRICS 2
arterial lactate with nearly comparable predictive ability for neonatal morbidity at term. Umbilical venous lactate may be used as a measure of neonatal morbidity risk when arterial blood is not available.
101 Barrier analysis: using quality improvement methodology to decrease health disparities in recurrent preterm birth Jodi Abbott1, Carolyn Smith-Lin1, Renee O’Toole2, Aviva Lee-Parritz1
ajog.org
interventions to reduce recurrent SPTD 5) Partnered with hospital pharmacy to create financially viable route for 17OHP availability RESULTS: During the course of the project (1/1/2013-2/28/2015) d EHR documentation of SPTD counseling for prevention rose from 0 to 88%. d In eligible patients, the rate of interventions rose from 37% to 89%, a 58% increase, close to goal attainment. d There was a decrease in the rate of recurrent preterm birth from 29% to 8%, a 73% reduction. CONCLUSION: A barrier analysis is effective in creating successful interventions to reduce recurrent preterm birth in an urban safety net hospital. The reduction in preterm birth after consistent use of serial cervical ultrasounds and progesterone yielded a greater rate of reduction in recurrent SPTD than that predicted by published data, in a particularly high risk population. Cost savings are calculated at $65000 per 38 preterm births averted annually, $2.47 million. Interventions that focus on patient education and empowerment are a key component to reducing health disparities preterm birth.
102 RCT of azithromycin-based extended-spectrum antibiotic prophylaxis for cesarean delivery: role of placental colonization with ureaplasma or mycoplasma
OBJECTIVE: 90% of women at Boston Medical Center, the largest
Alan Tita, M.D., Ph.D.1, Ken Waites2, Victoria Jauk1, Joseph Biggio1, Amelia Sutton1, Jeff Szychowski1, John Hauth1, William Andrews1
safety net hospital in New England, with a prior spontaneous preterm delivery (SPTD) will have serial cervical ultrasounds and counseling for progesterone in a subsequent pregnancy by January 2015. STUDY DESIGN: A Barrier Analysis was performed. This revealed 4 major types of barriers: 1) Patients: Women had a lack of awareness of preterm birth or interventions for prevention. Women demonstrated lack of self-advocacy in treatment settings. More than 50% of patient’s primary language is not English. 2)Providers: There are multiple types of prenatal care providers in our community, other than Obstetrician Gynecologists, including Family Medicine physicians, midwives and nurse practitioners. There was a lack of provider awareness of the patient’s history SPTD or interventions to prevent recurrence. 3) Suboptimal use of Electronic Health Record (EHR) 4) Challenges obtaining 17OH progesterone (17OHP) Interventions based on barrier analysis: 1) Tracked the counseling of women with primary SPTD. 2) Standardized counseling and documentation. 3) Created multiple points for patient identification 4) Acted as a key driver to increase community prenatal provider awareness of
OBJECTIVE: The mechanism by which extended spectrum (ES) antibiotic prophylaxis (AP) with azithromycin (AZI) reduces postcesarean (CD) infection by 50% is uncertain. We determined the effects of ES AP on placental colonization with ureaplasmas and mycoplasmas and assessed differential impact on post-CD infections. STUDY DESIGN: The multicenter double-blind C/SOAP RCT (CT.gov NCT01235546), included women 24 wks’ GA who had CD during (labor or at least 4 hrs after membrane rupture) and received standard AP (cefazolin). Subjects were randomized to also receive either AZI (500mg in 250ml saline) or identical placebo (250ml saline) given pre-incision (or as soon as possible after). In a substudy, chorioamnion and placenta specimens from all subjects at a single-center were blindly tested for genital Ureaplasma and Mycoplasma species by culture and real-time PCR. The centrally adjudicated primary outcome for this sub-study was a composite of endometritis, wound infection, or other rare infections (abdominopelvic abscess, sepsis, pelvic septic thrombophlebitis) within 6
1
Boston University School of Medicine, Boston, MA, 2SUNY Downstate, Boston, MA
1
University of Alabama at Birmingham, Center for Women’s Reproductive Health, Birmingham, AL, 2University of Alabama at Birmingham, Birmingham, AL
S70 American Journal of Obstetrics & Gynecology Supplement to JANUARY 2016