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Quality Improvement Campaign Increases Use of Steroids to Reduce Complications of Preterm Births in Pregnant Women

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Press Release Date: January 5, 1999

A multi-part intervention to improve the care that physicians give to pregnant women has been successful and shows promise of decreasing infant mortality and disability in preterm infants. The goal of the intervention, conducted by researchers at the University of Alabama, Birmingham, was to increase the appropriate prescription of corticosteroids, a type of steroid, that can reduce the complications of pre-term births in children born to at risk women. According to a study published in the January 6, Journal of the American Medical Association (JAMA), this intervention resulted in a 33 percent increase in the use of corticosteroids.

The research, supported by the Agency for Health Care Policy and Research (AHCPR), focused on minority and other high risk women who tend to deliver preterm babies because of poor pregnancy weight gain, low pre-pregnancy weight, and other related lifestyle issues. Corticosteroid use is known to be one of the most effective ways

The AHCPR Low Birthweight PORT (Patient Outcomes Research Team) researchers used a five-step intervention to increase a doctors' use of corticosteroids. The quality improvement program included enlisting local medical opinion leaders to encourage doctors to administer corticosteroids, lectures for doctors on corticosteroids, reminders in medical charts to use them, regular discussions with doctors on the various preterm scenarios, and ongoing feedback on their job performance.

Although a National Institutes of Health Consensus Conference and several medical societies have endorsed the use of corticosteroids to reduce the complications of preterm delivery, they are underused by the medical community. According to Laura C. Leviton, PhD, and Robert L. Goldenberg, M.D., of the University of Alabama at Birmingham, reasons for this low use include the fact that many obstetricians underestimate the benefits of corticosteroids; and hospital obstetrical practices for preterm labor do not always allow for the best timing of administering corticosteroids.

"These results demonstrate that tested and timely interventions must accompany the dissemination of evidence-based information to translate research into practice," says AHCPR's administrator John M. Eisenberg, M.D. "Information is a necessary, but not sufficient condition for the improvement of health care. By using system changes and opinion leaders as well as evidence-based information, this study demonstrates the effectiveness of the most modern theories of health care quality improvement."

AHCPR is also releasing today the final report of its five-year-long Low Birthweight PORT. The researchers provide detailed findings on topics such as: bacterial vaginosis, preeclampsia and low-dose aspirin therapy, biochemical predictors of preterm birth, prevention-based findings, and neonatal intensive care. Findings from this study are summarized for clinicians in a two-page Clinical Highlight to be released today.

Select to access online versions of the Clinical Highlight and the report's abstract and bibliography.

Free print copies of the Final Report: Low Birthweight in Minority and High-Risk Women (No. 98-N005) and the Clinical Highlight (No. 99-P005) are available from the AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907; the telephone number is 800-358-9295.

Editor's Note: The JAMA article is entitled: "A Randomized Controlled Trial of Methods to Encourage the Use of Antenatal Corticosteroid Therapy for Fetal Maturation," co-authored by Laura C. Leviton, PhD, Robert L. Goldenberg, M.D., C. Suzanne Baker, RN, MPH, and others. For interviews with Dr. Leviton and Dr. Goldenberg, the PORT's Principal Investigator, please contact Laura Mansfield at (205) 934-3889.

For additional information, contact AHCPR Public Affairs: Ellen McGovern, (301) 427-1863, or Karen Migdail, (301) 427-1855 .

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