title: The impact of clinical reminders on prenatal care.
abstract: OBJECTIVE
  This study assessed the effect of automated prenatal care reminders on adherence to standards of prenatal care at two family medicine teaching clinics.
  
  
  METHODS
  This was a reversal-design prospective study using medical records of prenatal patients during baseline, intervention, and post-intervention periods.
  
  
  RESULTS
  A total of 9.5% of patients received all guideline-recommended care at baseline compared to 55.7% in the intervention period, decreasing to 17.1% after the intervention. The most commonly missed services were offering first trimester aneuploidy screening and genetic screening, HIV screening, considering the need for repeat third trimester gonorrhea and chlamydia (GC/Chl) screening, and influenza vaccination. The clinical reminders significantly improved the number of patients offered HIV testing, given influenza vaccination, and tested or considered for repeat GC/Chl. Improvement in first trimester aneuploidy screening approached but did not meet statistical significance due to lower numbers of patients qualifying for this service. HIV testing and repeat GC/Chl screening significantly decreased in the post-intervention period, and compliance with most other standards trended downward as well.
  
  
  CONCLUSIONS
  Adherence to prenatal care standards by resident and faculty family medicine providers at baseline was less than optimal. Clinical reminders significantly improved overall adherence to prenatal standards and improved compliance with the most commonly missed standards. When the reminders were no longer active, compliance regressed toward baseline levels. These results support the use of prenatal care reminders as an effective way to help family physicians provide and document comprehensive prenatal care.
authors.affiliation: Department of Family Medicine, University of Michigan, MI, USA. marriley@med.umich.edu
authors.forename: Margaret
authors.initials: M
authors.lastname: Riley
authors.forename: Susan
authors.initials: S
authors.lastname: Galang
authors.forename: Lee A
authors.initials: LA
authors.lastname: Green
mesh_terms: D005194:Family Practice / Q000592:standards*; D005260:Female; D005865:Gestational Age; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008499:Medical Records; D010821:Physicians, Family; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards*; D011446:Prospective Studies; D011787:Quality of Health Care; D017010:Reminder Systems