title: Use and attitudes of obstetricians toward 3 high-risk interventions in MFMU Network hospitals.
abstract: OBJECTIVE
  We sought to evaluate the frequency of, and factors associated with, the use of 3 evidence-based interventions: antenatal corticosteroids for fetal lung maturity, progesterone for prevention of recurrent preterm birth, and magnesium sulfate for fetal neuroprotection.
  
  
  METHODS
  A self-administered survey was conducted from January through May 2011 among obstetricians from 21 hospitals that included 30 questions regarding their knowledge, attitudes, and practice of the 3 evidence-based interventions and the 14-item short version of the Team Climate for Innovation survey. Frequency of use of each intervention was ascertained from an obstetrical cohort of women between January 2010 and February 2011.
  
  
  RESULTS
  A total of 329 obstetricians (74% response rate) who managed 16,946 deliveries within the obstetrical cohort participated in the survey. More than 90% of obstetricians reported that they incorporated each intervention into routine practice. Actual frequency of administration in women eligible for the treatments was 93% for corticosteroids, 39% for progesterone, and 71% for magnesium sulfate. Provider satisfaction with quality of treatment evidence was 97% for corticosteroids, 82% for progesterone, and 57% for magnesium sulfate. Obstetricians perceived that barriers to treatment were most frequent for progesterone (76%), 30% for magnesium sulfate, and 17% for corticosteroids. Progesterone use was more frequent among patients whose provider reported the quality of the evidence was above average to excellent compared with poor to average (42% vs 25%, respectively; P < .001), and they were satisfied with their knowledge of the intervention (41% vs 28%; P = .02), and was less common among patients whose provider reported barriers to hospital or pharmacy drug delivery (31% vs 42%; P = .01). Corticosteroid administration was more common among patients who delivered at hospitals with 24 hours a day-7 days a week maternal-fetal medicine specialist coverage (93% vs 84%; P = .046), CONCLUSION: Obstetricians in Maternal-Fetal Medicine Units Network hospitals frequently use these evidence-based interventions; however, progesterone use was found to be related to their assessment of evidence quality. Neither progesterone nor the other interventions were associated with overall climate of innovation within a hospital as measured by the Team Climate for Innovation. National Institutes of Health Consensus Conference Statements may also have an impact on use; there is such a statement for antenatal corticosteroids but not for progesterone for preterm prevention or magnesium sulfate for fetal neuroprotection.
authors.affiliation: Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY. Electronic address: sb1080@columbia.edu.
authors.forename: Sabine Zoghbi
authors.initials: SZ
authors.lastname: Bousleiman
authors.affiliation: Department of Obstetrics and Gynecology, George Washington University Biostatistics Center, Washington, DC.
authors.forename: Madeline Murguia
authors.initials: MM
authors.lastname: Rice
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX.
authors.forename: Joan
authors.initials: J
authors.lastname: Moss
authors.affiliation: Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors.forename: Allison
authors.initials: A
authors.lastname: Todd
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
authors.forename: Monica
authors.initials: M
authors.lastname: Rincon
authors.affiliation: Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Gail
authors.initials: G
authors.lastname: Mallett
authors.affiliation: Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Milluzzi
authors.affiliation: Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI.
authors.forename: Donna
authors.initials: D
authors.lastname: Allard
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC.
authors.forename: Karen
authors.initials: K
authors.lastname: Dorman
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, TX.
authors.forename: Felecia
authors.initials: F
authors.lastname: Ortiz
authors.affiliation: Department of Obstetrics and Gynecology, The Ohio State University School of Medicine, Columbus, OH.
authors.forename: Francee
authors.initials: F
authors.lastname: Johnson
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Peggy
authors.initials: P
authors.lastname: Reed
authors.affiliation: Department of Obstetrics and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
authors.forename: Susan
authors.initials: S
authors.lastname: Tolivaisa
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D001291:Attitude of Health Personnel; D003625:Data Collection; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008278:Magnesium Sulfate / Q000627:therapeutic use*; D018696:Neuroprotective Agents / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D047928:Premature Birth / Q000188:drug therapy* / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods; D011374:Progesterone / Q000627:therapeutic use*; D011372:Progestins / Q000627:therapeutic use; D012008:Recurrence; D014481:United States
chemical_list: D000305:Adrenal Cortex Hormones; D018696:Neuroprotective Agents; D011372:Progestins; D011374:Progesterone; D008278:Magnesium Sulfate
keywords: Maternal-Fetal Medicine Units Network; antenatal corticosteroids; evidence-based interventions; magnesium sulfate; progesterone