Methods to encourage the use of antenatal corticosteroid therapy for fetal maturation. A randomized controlled trial

Laura C. Leviton, Robert L. Goldenberg, C. Suzanne Baker, Rachel M. Schwartz, Margaret C. Freda, Larry J. Fish, Suzanne P. Cliver, Dwight J. Rouse, Cynthia Chazotte, Irwin R. Merkatz, James M. Raczynski

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Abstract

Context: Antenatal corticosteroids for fetal maturation have been underused, despite evidence for their benefits in cases of preterm birth. Objective: To evaluate dissemination strategies aimed at increasing appropriate use of this therapy. Design and Setting: Twenty-seven tertiary care institutions were randomly assigned to either usual dissemination of practice recommendations (n = 14) or usual dissemination plus an active, focused dissemination effort (n = 13). Subjects: Obstetricians and their preterm delivery cases at participating hospitals. Intervention: Recommendations by a National Institutes of Health (NIH) Consensus Conference held in late February-early March 1994 were disseminated in early May 1994. Usual dissemination was publication of the recommendations and endorsement by the American College of Obstetricians and Gynecologists. Active dissemination was a year-long educational effort led by an influential physician and a nurse coordinator at each facility, consisting of grand rounds, a chart reminder system, group discussion of case scenarios, monitoring, and feedback. Main Outcome Measure: Use or nonuse of antenatal corticosteroids was abstracted from medical records of eligible women delivering at the participating hospitals in the 12 months immediately prior to release of the NIH recommendations (average number of records abstracted, 130) and in the 12 months following their release (average number of records abstracted, 122). Results: Active dissemination significantly increased the odds of corticosteroid use after the conference. Use increased from 33.0% of eligible patients receiving corticosteroids to 57.6%, or by 75% over baseline, in usual dissemination hospitals. Use increased from 32.9% to 68.3%, or an 108% increase, in active dissemination hospitals. Gestational age and maternal diagnosis affected use of the therapy in complex ways. Conclusion: An active, focused dissemination effort increased the effectiveness of usual dissemination methods when combined with key principles to change physician practices.

Original languageEnglish (US)
Pages (from-to)46-52
Number of pages7
JournalJournal of the American Medical Association
Volume281
Issue number1
DOIs
StatePublished - Jan 6 1999

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Fetal Therapies
Adrenal Cortex Hormones
Randomized Controlled Trials
National Institutes of Health (U.S.)
Reminder Systems
Surrogate Mothers
Teaching Rounds
Physicians
Premature Birth
Tertiary Healthcare
Gestational Age
Medical Records
Publications
Nurses
Outcome Assessment (Health Care)
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Leviton, L. C., Goldenberg, R. L., Baker, C. S., Schwartz, R. M., Freda, M. C., Fish, L. J., ... Raczynski, J. M. (1999). Methods to encourage the use of antenatal corticosteroid therapy for fetal maturation. A randomized controlled trial. Journal of the American Medical Association, 281(1), 46-52. https://doi.org/10.1001/jama.281.1.46

Methods to encourage the use of antenatal corticosteroid therapy for fetal maturation. A randomized controlled trial. / Leviton, Laura C.; Goldenberg, Robert L.; Baker, C. Suzanne; Schwartz, Rachel M.; Freda, Margaret C.; Fish, Larry J.; Cliver, Suzanne P.; Rouse, Dwight J.; Chazotte, Cynthia; Merkatz, Irwin R.; Raczynski, James M.

In: Journal of the American Medical Association, Vol. 281, No. 1, 06.01.1999, p. 46-52.

Research output: Contribution to journalArticle

Leviton, LC, Goldenberg, RL, Baker, CS, Schwartz, RM, Freda, MC, Fish, LJ, Cliver, SP, Rouse, DJ, Chazotte, C, Merkatz, IR & Raczynski, JM 1999, 'Methods to encourage the use of antenatal corticosteroid therapy for fetal maturation. A randomized controlled trial', Journal of the American Medical Association, vol. 281, no. 1, pp. 46-52. https://doi.org/10.1001/jama.281.1.46
Leviton, Laura C. ; Goldenberg, Robert L. ; Baker, C. Suzanne ; Schwartz, Rachel M. ; Freda, Margaret C. ; Fish, Larry J. ; Cliver, Suzanne P. ; Rouse, Dwight J. ; Chazotte, Cynthia ; Merkatz, Irwin R. ; Raczynski, James M. / Methods to encourage the use of antenatal corticosteroid therapy for fetal maturation. A randomized controlled trial. In: Journal of the American Medical Association. 1999 ; Vol. 281, No. 1. pp. 46-52.
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abstract = "Context: Antenatal corticosteroids for fetal maturation have been underused, despite evidence for their benefits in cases of preterm birth. Objective: To evaluate dissemination strategies aimed at increasing appropriate use of this therapy. Design and Setting: Twenty-seven tertiary care institutions were randomly assigned to either usual dissemination of practice recommendations (n = 14) or usual dissemination plus an active, focused dissemination effort (n = 13). Subjects: Obstetricians and their preterm delivery cases at participating hospitals. Intervention: Recommendations by a National Institutes of Health (NIH) Consensus Conference held in late February-early March 1994 were disseminated in early May 1994. Usual dissemination was publication of the recommendations and endorsement by the American College of Obstetricians and Gynecologists. Active dissemination was a year-long educational effort led by an influential physician and a nurse coordinator at each facility, consisting of grand rounds, a chart reminder system, group discussion of case scenarios, monitoring, and feedback. Main Outcome Measure: Use or nonuse of antenatal corticosteroids was abstracted from medical records of eligible women delivering at the participating hospitals in the 12 months immediately prior to release of the NIH recommendations (average number of records abstracted, 130) and in the 12 months following their release (average number of records abstracted, 122). Results: Active dissemination significantly increased the odds of corticosteroid use after the conference. Use increased from 33.0{\%} of eligible patients receiving corticosteroids to 57.6{\%}, or by 75{\%} over baseline, in usual dissemination hospitals. Use increased from 32.9{\%} to 68.3{\%}, or an 108{\%} increase, in active dissemination hospitals. Gestational age and maternal diagnosis affected use of the therapy in complex ways. Conclusion: An active, focused dissemination effort increased the effectiveness of usual dissemination methods when combined with key principles to change physician practices.",
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