title: Improved prenatal detection of congenital heart disease in an integrated health care system.
abstract: The reported prenatal detection rates (PDRs) for significant congenital heart disease (sCHD) have been suboptimal, even in the current era. Changes in prenatal ultrasound policy and training may lead to improved prenatal detection of sCHD. This study analyzed the results of a policy to assess fetal cardiac outflow tracts shown by screening prenatal ultrasound using the electronic medical record (EMR). During a 6-year period, fetuses and patients younger than 1 year with sCHD were identified. The EMR was used to gather detection and outcome data. As an internal control within the same health care system, the PDR of only the surgical cases was compared with that of a similar group in which documentation of the fetal cardiac outflow tracts was not standard policy. Among 25,666 births, sCHD was identified in 93 fetuses or patients, yielding an incidence of 3.6 per 1,000 births. The PDR was 74.1%. Detection after birth but before discharge was 20.4%, and detection after discharge was 5.4%. A significant improvement in the PDR of sCHD was found when a concerted effort was made to obtain fetal cardiac outflow tract views during pregnancy screening (59.3 vs. 28%). Within an integrated health care system and with the use of an EMR, a PDR of 74% can be obtained, and 94% of sCHD can be detected before discharge. A concerted program that includes documentation of fetal cardiac outflow tracts in the pregnancy screening can result in improved PDR of sCHD.
authors.affiliation: Division of Cardiology, Department of Pediatrics, Southern California Permanente Medical Group, Kaiser Permanente, 4405 Vandever Avenue, San Diego, CA 92120, USA. denislevy@hotmail.com
authors.forename: Denis J
authors.initials: DJ
authors.lastname: Levy
authors.forename: Dolores H
authors.initials: DH
authors.lastname: Pretorius
authors.forename: Abraham
authors.initials: A
authors.lastname: Rothman
authors.forename: Marcos
authors.initials: M
authors.lastname: Gonzales
authors.forename: Cherie
authors.initials: C
authors.lastname: Rao
authors.forename: Mark E
authors.initials: ME
authors.lastname: Nunes
authors.forename: Julian
authors.initials: J
authors.lastname: Bendelstein
authors.forename: Karen
authors.initials: K
authors.lastname: Mehalek
authors.forename: Amy
authors.initials: A
authors.lastname: Thomas
authors.forename: Candace
authors.initials: C
authors.lastname: Nehlsen
authors.forename: Jessica
authors.initials: J
authors.lastname: Ehr
authors.forename: Raoul J
authors.initials: RJ
authors.lastname: Burchette
authors.forename: Mark S
authors.initials: MS
authors.lastname: Sklansky
mesh_terms: D002140:California; D016009:Chi-Square Distribution; D016208:Databases, Factual; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D057286:Electronic Health Records; D005260:Female; D005865:Gestational Age; D018166:Health Care Reform; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011050:Policy Making; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000592:standards; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016216:Ultrasonography, Prenatal / Q000592:standards*