Promoting antenatal steroid use for fetal maturation: results from the California Perinatal Quality Care Collaborative.
OBJECTIVE
The California Perinatal Quality Care Collaborative (CPQCC) was formed to seek perinatal care improvements by creating a confidential multi-institutional database to identify topics for quality improvement (QI). We aimed to evaluate this approach by assessing antenatal steroid administration before preterm (24 to 33 weeks of gestation) delivery. We hypothesized that mean performance would improve and the number of centers performing below the lowest quartile of the baseline year would decrease.


METHODS
In 1998, a statewide QI cycle targeting antenatal steroid use was announced, calling for the evaluation of the 1998 baseline data, dissemination of recommended interventions using member-developed educational materials, and presentations to California neonatologists in 1999-2000. Postintervention data were assessed for the year 2001 and publicly released in 2003. A total of 25 centers voluntarily participated in the intervention.


RESULTS
Antenatal steroid administration rate increased from 76% of 1524 infants in 1998 to 86% of 1475 infants in 2001 (P < .001). In 2001, 23 of 25 hospitals exceeded the 1998 lower-quartile cutoff point of 69.3%.


CONCLUSIONS
Regional collaborations represent an effective strategy for improving the quality of perinatal care.
Wirtschafter
David D
DD
California Perinatal Quality Care Collaborative, Palo Alto, California, USA. david.wirtschafter@juno.com
Danielsen
Beate H
BH
Main
Elliott K
EK
Korst
Lisa M
LM
Gregory
Kimberly D
KD
Wertz
Andrew
A
Stevenson
David K
DK
Gould
Jeffrey B
JB
D002140:California; D016208:Databases, Factual; D017723:Drug Utilization Review; D005260:Female; D005325:Fetal Organ Maturity; D005865:Gestational Age; D019983:Guideline Adherence; D006764:Hospitals, Community; D006769:Hospitals, General; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D018743:Perinatal Care; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage*
D013256:Steroids