title: The family medicine residency training initiative in miscarriage management: impact on practice in Washington State.
abstract: OBJECTIVE
  Non-complicated spontaneous abortion cases should be counseled about the full range of management approaches, including uterine evacuation using manual vacuum aspiration (MVA). The Residency Training Initiative in Miscarriage Management (RTI-MM) is an intensive, multidimensional intervention designed to facilitate implementation of office-based management of spontaneous abortion using MVA in family medicine residency settings. The purpose of this study was to test the impact of the RTI-MM on self-reported use of MVA for management of spontaneous abortion.
  
  
  METHODS
  We used a pretest/posttest one group study design and a web-based, anonymous survey to collect data on knowledge, attitudes, perceived barriers, and practice of office-based management of spontaneous abortion. We used multivariable models to estimate incident relative risks and accounted for data clustering at the residency site level.
  
  
  RESULTS
  Our sample included 441 residents and faculty from 10 family medicine residency sites. Our findings show a positive association between the RTI-MM and self-reported use of MVA for management of spontaneous abortion (adjusted RR=9.11 [CI=4.20--19.78]) and were robust to model specification. Male gender, doing any type of management of spontaneous abortion (eg, expectant, medication), other on-site reproductive health training interventions, and support staff knowledge scores were also significant correlates of physician practice of MVA.
  
  
  CONCLUSIONS
  Our findings suggest that the RTI-MM was successful in influencing the practice of management of spontaneous abortion using MVA in this population and that support staff knowledge may impact physician practice. Integrating MVA into family medicine settings would potentially improve access to evidence-based, comprehensive care for women.
authors: Department of Medical Informatics and Clinical Epidemiology and Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR 97239, USA. darneyb@ohsu.edu
authors: Blair G
authors: BG
authors: Darney
authors: Marcia R
authors: MR
authors: Weaver
authors: Nancy
authors: N
authors: Stevens
authors: Jeana
authors: J
authors: Kimball
authors: Sarah W
authors: SW
authors: Prager
mesh_terms: D000022:Abortion, Spontaneous / Q000628:therapy*; D001291:Attitude of Health Personnel; D005194:Family Practice / Q000193:education*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D014619:Vacuum Curettage / Q000193:education* / Q000706:statistics & numerical data; D014861:Washington
references: Am J Obstet Gynecol. 2011 Jun;204(6):493.e1-6
references: 21419385
references: Am J Epidemiol. 2003 May 15;157(10):940-3
references: 12746247
references: Am Fam Physician. 2011 Jul 1;84(1):75-82
references: 21766758
references: Fam Med. 1998 Apr;30(4):293-6
references: 9568501
references: Obstet Gynecol. 2006 Jul;108(1):103-10
references: 16816063
references: Am J Community Psychol. 2007 Jun;39(3-4):191-6
references: 17510793
references: Am J Epidemiol. 2004 Apr 1;159(7):702-6
references: 15033648
references: Obstet Gynecol. 1998 Feb;91(2):247-53
references: 9469284
references: J Womens Health (Larchmt). 2007 Dec;16(10):1429-36
references: 18062758
references: Contraception. 2005 Feb;71(2):84-8
references: 15707555
references: Obstet Gynecol. 2004 Jan;103(1):101-7
references: 14704252
references: Obstet Gynecol Surv. 2001 Feb;56(2):105-13
references: 11219590
references: Ann Fam Med. 2003 Jul-Aug;1(2):97-104
references: 15040439
references: Health Serv Res. 2005 Feb;40(1):213-26
references: 15663710
references: Prev Med. 2005 Jun;40(6):729-34
references: 15850872
references: Fam Med. 1998 Jun;30(6):421-3
references: 9624520
references: Contraception. 2009 May;79(5):331-3
references: 19341842
references: JAMA. 1999 Sep 1;282(9):867-74
references: 10478694
references: Health Care Manage Rev. 2002 Summer;27(3):35-47
references: 12146782
references: BMJ. 1997 Aug 16;315(7105):418-21
references: 9277610
references: Am J Obstet Gynecol. 2010 Jun;202(6):531.e1-8
references: 20227674
references: J Health Serv Res Policy. 2001 Jan;6(1):23-31
references: 11219356
references: Am J Epidemiol. 2004 Aug 15;160(4):301-5
references: 15286014
references: Fam Med. 2005 Apr;37(4):242-4
references: 15812688
references: Patient Educ Couns. 2010 Dec;81(3):454-61
references: 21093193
references: J Reprod Med. 2005 Jul;50(7):486-90
references: 16130844
references: Contraception. 2003 Mar;67(3):207-12
references: 12618255
references: Fam Med. 2007 May;39(5):337-42
references: 17476607
references: Med Care. 2001 Aug;39(8 Suppl 2):II2-45
references: 11583120
references: Fam Med. 2007 Jun;39(6):399-403
references: 17549648
references: Int J Gynaecol Obstet. 1994 Jun;45(3):261-7
references: 7926246
references: Fam Med. 2008 Mar;40(3):204-7
references: 18320400
references: Lancet. 2003 Oct 11;362(9391):1225-30
references: 14568747
references: Fam Med. 2008 Apr;40(4):248-52
references: 18481404
references: J Womens Health (Larchmt). 2009 Jun;18(6):787-93
references: 19445643
references: Cochrane Database Syst Rev. 2006 Apr 19;(2):CD003518
references: 16625583
references: Am J Obstet Gynecol. 2007 May;196(5):445.e1-5
references: 17466695