title: Increased adherence to prenatal group B streptococcal screening guidelines through a paired electronic reminder and education intervention.
abstract: The 2010 Centers for Disease Control and Prevention (CDC) update on perinatal group B streptococcal (GBS) prevention advises universal vaginal-rectal GBS screening of pregnant women in the 35th through 37th week of gestation. Because GBS colonization is transient, a test performed more than 5 weeks before delivery may not have sufficient negative predictive value to be clinically useful. Our objective was to increase rates of quality-improved, CDC-adherent GBS screening and decrease repeat screening. A reminder for maternal vaginal-rectal GBS testing was added to the physicians' electronic ordering screen, and family medicine physicians and residents were educated about screening guidelines through standardized, in-person presentations. Retrospective chart review was performed before and after these interventions. Univariate or bivariate analysis was performed for demographic factors, timing of first screen, rates of CDC-adherent screening (the newly defined quality-improved screen and the usual screen), and rates of repeat and unnecessary screens. Multivariate analysis was performed with quality-improved and usual screening as dependent variables. Bivariate analysis showed that post-intervention rates of quality-improved screening increased from 30 to 62 % (P < .001), usual screening increased from 69 to 84 % (P = .005), and repeat GBS screening decreased from 20 to 8 % (P = .007). Multivariate analysis showed increased post-intervention odds of quality-improved screening [odds ratio (OR) 3.59; 95 % CI 2.07-6.34] and usual screening (OR 2.67; 95 % CI 1.40-5.25). Low-cost, reproducible quality improvement interventions (electronic order reminder, educational sessions) have the potential to increase guideline adherence for GBS screening in pregnant women and decrease repeat screening.
authors: Department of Family Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. maclaughlin.kathy@mayo.edu.
authors: Kathy L
authors: KL
authors: MacLaughlin
authors: Department of Family Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
authors: Gregory M
authors: GM
authors: Garrison
authors: Department of Family Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
authors: Marc R
authors: MR
authors: Matthews
authors: Department of Family Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
authors: Marcia L
authors: ML
authors: O'Brien
authors: Department of Family Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
authors: Elizabeth
authors: E
authors: Westby
authors: Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors: Paul V
authors: PV
authors: Targonski
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002487:Centers for Disease Control and Prevention, U.S. / Q000592:standards; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010821:Physicians, Family / Q000193:education* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000639:trends; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D011296:Prenatal Diagnosis / Q000379:methods / Q000592:standards*; D017010:Reminder Systems; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D013292:Streptococcus agalactiae / Q000302:isolation & purification*; D014481:United States; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents