Methods to Encourage the Use of Antenatal Corticosteroid Therapy for Fetal Maturation

Abstract

ContextAntenatal corticosteroids for fetal maturation have been underused, despite evidence for their benefits in cases of preterm birth.ObjectiveTo evaluate dissemination strategies aimed at increasing appropriate use of this therapy.Design and SettingTwenty-seven tertiary care institutions were randomly assigned to either usual dissemination of practice recommendations (n=14) or usual dissemination plus an active, focused dissemination effort (n=13).SubjectsObstetricians and their preterm delivery cases at participating hospitals.InterventionRecommendations by a National Institutes of Health (NIH) Consensus Conference held in late February–early March 1994 were disseminated in early May 1994. Usual dissemination was publication of the recommendations and endorsement by the American College of Obstetricians and Gynecologists. Active dissemination was a year-long educational effort led by an influential physician and a nurse coordinator at each facility, consisting of grand rounds, a chart reminder system, group discussion of case scenarios, monitoring, and feedback.Main Outcome MeasureUse or nonuse of antenatal corticosteroids was abstracted from medical records of eligible women delivering at the participating hospitals in the 12 months immediately prior to release of the NIH recommendations (average number of records abstracted, 130) and in the 12 months following their release (average number of records abstracted, 122).ResultsActive dissemination significantly increased the odds of corticosteroid use after the conference. Use increased from 33.0% of eligible patients receiving corticosteroids to 57.6%, or by 75% over baseline, in usual dissemination hospitals. Use increased from 32.9% to 68.3%, or an 108% increase, in active dissemination hospitals. Gestational age and maternal diagnosis affected use of the therapy in complex ways.ConclusionAn active, focused dissemination effort increased the effectiveness of usual dissemination methods when combined with key principles to change physician practices.