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Non-Medically Indicated Delivery Prior to 39 Weeks Gestation in United States Hospitals_Nate DeNicola_ 5_3_13


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Non-Medically Indicated Delivery Prior to 39 Weeks Gestation in United States Hospitals_Nate DeNicola_ 5_3_13

  1. 1. Non-medically indicated delivery prior to 39 weeks gestationin United States hospitalsNathaniel G. DeNicola, MD; Andrew J. Epstein, PhD; Sindhu K. Srinivas, MD, MSCE Excluded: no L&D unit listed in AHAdatabase, self-reported no L&D unit, or hospitalonly performed emergency deliveries Test/re-test reliability: different caller assignedrandom selection of 10% of original call list Telephone survey with all US L&D units duringan 8 week timeframe: July 1 – August 31, 2012 Script developed from multi-site focusedinterviews with L&D nurses, followed by pilottrial with 10 hospitals: included study disclosure Three callers each assigned random selection of890 hospitals containing 50 states Survey conducted as “cold call” with ChargeNurse or Nurse Manager on L&D to determine ifthe hospital has a specific policy for NMIdelivery < 39 weeksMethods Results The national movement to eliminate NMIdelivery < 39 weeks has prompted manyhospitals to develop specific policies; in ourstudy the majority, 66.5%, reported a policy. Telephone survey via “cold call” to ChargeNurses or Nurse Managers can be an effectivemethod for contacting operational points in thehealth care system: 8% response rate. States with a policy initiative had a significantlyhigher proportion of hospitals reporting aspecific policy against NMI delivery < 39 weeks.Conclusions State initiatives – independently or incoordination with state government –can serve an important role inencouraging hospitals to adopt specificpolicies. Additional studies linking hospital policywith neonatal outcomes could furtherour understanding of hospital policy inadvancing perinatal health. The reality of operational hospitalpolicy may differ from written hospitalpolicy – investigating thiscommunication is an important step inoptimizing the benefit of policy designand implementation.Policy Implications Overall 1,228 Yes-policy hospitals in initiative states (67.8%)vs. 345 Yes-policy hospitals in non-initiative states (62.1%)p<0.012; Highest Yes% among self-reported initiative states:> 1 hospital reported policy initiative in interview p<0.0001. Background. Non-medically indicated (NMI)delivery prior to 39 weeks gestation (<39weeks) is clearly associated with increasedneonatal morbidity. Objectives. To determine the prevalence of UShospital-level policy that specifically addressesNMI delivery <39 weeks. Methods. Telephone survey of all US labor &delivery units to determine presence and typeof hospital policy for NMI delivery < 39 weeks. Results. 2,367 of 2,641 (89.6%) hospitalsresponded: 66.5% “Yes”, 33.5% “No.” Stateswith policy initiatives reported a higherproportion of Yes-policy hospitals: 67.8% v62.1% (p < 0.012). The majority of policy codedas “hard stop” 68.8%. Conclusions. The national movement toeliminate NMI delivery < 39 weeks hasprompted many hospitals to develop specificpolicies. State initiatives represent aneffective approach in policy promotion.Abstract The American College of Obstetricians &Gynecologists (ACOG) has issued guidelinesagainst NMI delivery < 39 weeks; however thepractice continues to occur.Background1. Determine the prevalence of US hospital-levelpolicy that addresses NMI delivery < 39 weeksObjectivesYesHard StopOtherNo“Not Done” *UncertainReviewed bymultipleinvestigatorsResponse Coding* Respondents volunteered thatNMI was against standard of careTest / Re-test ReliabilityTotal hospitals contacted 2,641Respondents 2,367No answer/excluded 274Response Rate 89.6%Comparison Data %Concordance: Yes v No 151 / 214 70.5%Summary of ResponsesYes62%No38%Yes70%No30%Yes62%No38%Self-ReportedInitiative StatesN=1,240 in 18 statesOther States withIdentified InitiativeN=571 in 14 statesNon-Initiative StatesN=556 in 19 states< 45%45% – 65%65% – 80%> 80%Yes66%No34%“Not Done” 53%% Hospitals Reported Yes-Policy“Not Done” 63% “Not Done” 49% “Not Done” 41%