Appropriate Use of Progesterone to Prevent Preterm Birth: Approaches to Measurement for Driving Improvement
| Autor: | Ashley H. Hirai, Vanessa Lee, Priya Batra, Sabrina Selk, Michael C. Lu |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Quality management Epidemiology media_common.quotation_subject Population Birth certificate 03 medical and health sciences 0302 clinical medicine Pregnancy Surveys and Questionnaires 17 alpha-Hydroxyprogesterone Caproate Infant Mortality Outcome Assessment Health Care Hydroxyprogesterones medicine Humans Quality (business) 030212 general & internal medicine education media_common education.field_of_study 030219 obstetrics & reproductive medicine Actuarial science Medicaid business.industry Public health Infant Newborn Public Health Environmental and Occupational Health Infant Obstetrics and Gynecology United States Infant mortality Variety (cybernetics) Intervention (law) Pediatrics Perinatology and Child Health Premature Birth Female business |
| Zdroj: | Maternal and Child Health Journal. 21:446-451 |
| ISSN: | 1573-6628 1092-7875 |
| DOI: | 10.1007/s10995-016-2234-3 |
| Popis: | Introduction Despite strong evidence supporting the benefit of 17-alpha hydroxyprogesterone caproate (17P) in preventing recurrent preterm birth, this treatment still does not reach most eligible patients. This study sought to identify approaches to measuring the appropriate use of 17P, with the goal of helping health systems better monitor and improve the implementation of this intervention. Methods Semi-structured telephone interviews were used to gather data on measures for 17P use being developed and implemented by state team members participating in the Infant Mortality Collaborative Improvement and Innovation Network (IM CoIIN)-a national quality improvement initiative. Strengths and limitations of these measurement approaches were described. Results Six approaches to measuring 17P use to prevent preterm birth were identified: practice-level data, population-based surveys, three measures employing insurance claims with or without linked birth certificate data, and revised birth certificates. Each measure had particular strengths and limitations. Practice-level measures were useful in rapid-cycle improvement, but were not generalizable across sites. In contrast, population-based measures (i.e., surveys, claims) were useful for broad comparisons, but were limited in their timeliness, and in how accurately they identified candidates who were truly eligible for 17P. Additionally, such measures required complex data linkage and analytic capabilities. Discussion A variety of imperfect measures for the appropriate use of 17P are available. No "best" measure was identified-the optimal measurement option must fit the specific needs of a health agency. Better data infrastructure and harnessing information from integrated electronic health records could improve the quality of 17P use measurement for improvement efforts. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|