title: Effect of a Best Practice Alert on Gestational Weight Gain, Health Services, and Pregnancy Outcomes.
abstract: Objective To examine whether an electronic medical record "best practice alert" previously shown to improve antenatal gestational weight gain patient education resulted in downstream effects on service delivery or patient health outcomes. Methods This study involved secondary analysis of data from an intervention to improve provider behavior surrounding gestational weight gain patient education. Data were from retrospective chart reviews of patients who received care either before (N = 333) or after (N = 268) implementation of the intervention. Pre-post comparisons and multivariable logistic regression were used to analyze downstream effects of the intervention on health outcomes and obesity-related health services while controlling for potential confounders. Results The intervention was associated with an increase in the proportion of prenatal patients who gained weight within Institute of Medicine guidelines, from 28 to 35 % (p < .05). Mean total gestational weight gain did not change, but variability decreased such that post-intervention women had weight gains closer to their gestational weight gain targets. The intervention was associated with a 94 g decrease in mean infant birth weight (p = .03), and an increase in the proportion of overweight and obese women screened for undiagnosed Type 2 diabetes before 20 weeks gestation, from 13 to 25 % (p = .01). Conclusions for Practice The electronic medical record can be leveraged to promote healthy gestational weight gain and early screening for undiagnosed Type 2 diabetes. Yet most patients still need additional support to achieve gestational weight gain within Institute of Medicine guidelines.
authors.affiliation: Population Health Institute, Department of Population Health Sciences, University of Wisconsin - Madison, 610 Walnut St, Madison, WI, 53726, USA. smlindberg@wisc.edu.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Lindberg
authors.affiliation: Center for Women's Health and Health Disparities Research, Department of Obstetrics and Gynecology, University of Wisconsin - Madison, Madison, WI, USA.
authors.forename: Alexa
authors.initials: A
authors.lastname: DeBoth
authors.affiliation: Department of Obstetrics and Gynecology, University of Wisconsin - Madison, Madison, WI, USA.
authors.forename: Cynthie K
authors.initials: CK
authors.lastname: Anderson
mesh_terms: D000328:Adult; D019985:Benchmarking; D003376:Counseling / Q000379:methods* / Q000592:standards; D057286:Electronic Health Records / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006801:Humans; D062527:Meaningful Use; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care; D015397:Program Evaluation / Q000379:methods*; D012189:Retrospective Studies; D015430:Weight Gain; D014922:Wisconsin
keywords: Diabetes; Electronic health records; Obesity; Prenatal counseling; Prevention