Methods to encourage the use of antenatal corticosteroid therapy for fetal maturation: a randomized controlled trial.
BACKGROUND
Antenatal corticosteroids for fetal maturation have been underused, despite evidence for their benefits in cases of preterm birth.


OBJECTIVE
To evaluate dissemination strategies aimed at increasing appropriate use of this therapy.


METHODS
Twenty-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).


METHODS
Obstetricians and their preterm delivery cases at participating hospitals.


METHODS
Recommendations 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.


METHODS
Use 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).


RESULTS
Active 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%, oran 108% increase, in active dissemination hospitals. Gestational age and maternal diagnosis affected use of the therapy in complex ways.


CONCLUSIONS
An active, focused dissemination effort increased the effectiveness of usual dissemination methods when combined with key principles to change physician practices.
Leviton
L C
LC
Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, 35294-0033, USA. lleviton@hb.soph.uab.edu
Goldenberg
R L
RL
Baker
C S
CS
Schwartz
R M
RM
Freda
M C
MC
Fish
L J
LJ
Cliver
S P
SP
Rouse
D J
DJ
Chazotte
C
C
Merkatz
I R
IR
Raczynski
J M
JM
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001623:Betamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D015975:Consensus Development Conferences, NIH as Topic; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D004363:Drug Utilization; D005314:Embryonic and Fetal Development; D005260:Female; D005865:Gestational Age; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000517:prevention & control*; D007744:Obstetric Labor Complications / Q000517:prevention & control; D007752:Obstetric Labor, Premature / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D014481:United States
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D003907:Dexamethasone; D001623:Betamethasone