Increased adherence to prenatal group B streptococcal screening guidelines through a paired electronic reminder and education intervention

Matern Child Health J. 2014 Jan;18(1):16-21. doi: 10.1007/s10995-013-1228-7.

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.

MeSH terms

  • Adolescent
  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • Centers for Disease Control and Prevention, U.S. / standards
  • Female
  • Guideline Adherence / statistics & numerical data
  • Guideline Adherence / trends
  • Humans
  • Infectious Disease Transmission, Vertical / prevention & control*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Physicians, Family / education*
  • Physicians, Family / statistics & numerical data
  • Practice Patterns, Physicians' / trends
  • Pregnancy
  • Pregnancy Complications, Infectious / diagnosis*
  • Pregnancy Complications, Infectious / drug therapy
  • Pregnancy Complications, Infectious / microbiology
  • Prenatal Diagnosis / methods
  • Prenatal Diagnosis / standards*
  • Reminder Systems
  • Retrospective Studies
  • Streptococcal Infections / diagnosis*
  • Streptococcal Infections / drug therapy
  • Streptococcal Infections / microbiology
  • Streptococcus agalactiae / isolation & purification*
  • United States
  • Young Adult

Substances

  • Anti-Bacterial Agents