Quality Improvement Initiative for Aspirin Screening and Prescription Rates for Preeclampsia Prevention in an Outpatient Obstetric Clinic.

OBJECTIVE: Hypertensive disorders of pregnancy (HDP) impact 10% of pregnancies in the United States and cause adverse maternal and neonatal outcomes such as prematurity and low birth weight. Aspirin administration to at-risk individuals during pregnancy can reduce risk of HDP. STUDY DESIGN: Define-Measure-Assess-Improve-Control methodology was utilized to improve aspirin screening in an outpatient obstetric clinic. Retrospective cohort analysis compared outcome metrics pre- and postimplementation by using logistic regression models, adjusting for race and insurance. Key informant interviews and process mapping identified barriers to aspirin screening. A multidisciplinary team implemented low-cost strategies such as provider education, additional screening by ancillary staff, automated electronic reminders, and standardized patient counseling. RESULTS: Over 6 months, the screening rate improved from 62.5 to 92.0% (adjusted odds ratio [aOR] = 6.89, 95% confidence interval [CI]: 3.30-14.43). The prescription rate for patients correctly identified to be eligible for aspirin improved from 66.7 to 82.4% (aOR = 1.96, 95% CI: 0.88-4.35). CONCLUSION: Comprehensive, tailored quality improvement efforts can significantly increase aspirin screening and prescription, which may decrease maternal and neonatal morbidity due to HDP. KEY POINTS: · Initiative improved overall and correct screening rates.. · Initiative increased provider knowledge of eligibility.. · Low-cost interventions can have high impact over short time interval..

Health Disparities in Uterine Cancer: Report From the Uterine Cancer Evidence Review Conference.

The Centers for Disease Control and Prevention recognized the need for educational materials for clinicians on the prevention and early diagnosis of gynecologic cancers. The American College of Obstetricians and Gynecologists convened a panel of experts in evidence review from the Society for Academic Specialists in General Obstetrics and Gynecology and content experts from the Society of Gynecologic Oncology to review relevant literature, best practices, and existing practice guidelines for the development of evidence-based educational materials for women's health care clinicians about uterine cancer. This article is the evidence summary of the literature review of health disparities and inequities related to uterine cancer. Substantive knowledge gaps are noted and summarized to provide guidance for future research.

Executive Summary of the Uterine Cancer Evidence Review Conference.

The Centers for Disease Control and Prevention recognized the need for educational materials for clinicians on the prevention and early diagnosis of gynecologic cancers. The American College of Obstetricians and Gynecologists convened a panel of experts in evidence review from the Society for Academic Specialists in General Obstetrics and Gynecology and content experts from the Society of Gynecologic Oncology to review relevant literature, best practices, and existing practice guidelines as a first step toward developing evidence-based educational materials for women's health care clinicians about uterine cancer. Panel members conducted structured literature reviews, which were then reviewed by other panel members and discussed at a virtual meeting of stakeholder professional and patient advocacy organizations in January 2021. This article is the evidence summary of the relevant literature and existing recommendations to guide clinicians in the prevention, early diagnosis, and special considerations of uterine cancer. Substantive knowledge gaps are noted and summarized to provide guidance for future research.

Evaluation of adherence rates following ectopic pregnancy to inform management decisions in a public hospital system.

INTRODUCTION: Adherence to follow-up is an important consideration when treating non-emergent ectopic pregnancy. Our aim was to evaluate the management of ectopic pregnancy among patients in a public hospital system and to identify factors related to adherence of medical management in this population. MATERIAL AND METHODS: A retrospective review to evaluate the management of ectopic pregnancy among women in a public hospital system, including all women undergoing treatment for ectopic pregnancy from 2012 to 2017. Data were abstracted from the medical record. Women who were adherent to follow-up were compared to those who were non-adherent. Log-binomial regression was used to identify factors associated with management type and adherence to follow-up of medical management. RESULTS: Of 283 women diagnosed with an ectopic pregnancy, 182 (64.3%) were managed surgically and 101 (35.7%) were managed with methotrexate. Among non-emergent cases, presence of fetal cardiac activity, human chorionic gonadotropin (HCG) level ≥5000mIU/mL, ectopic size ≥3.5 cm, and multigravid status was associated with surgical management. Among patients receiving methotrexate, 66 (65.3%) adhered to required lab draws 4 and 7 days following methotrexate administration (+/-1 day). Among those receiving methotrexate 45.5% (n = 46) were lost to follow-up. Lower prevalence of adherence to follow-up (i.e. lab draws completed until pregnancy levels were negative) was observed among non-Hispanic African American (RR=0.64, 95%CI 0.45-0.94) compared to white women and women with multigravid status (RR=0.67, 95%CI 0.48-0.95) after adjustment. CONCLUSIONS: Nearly half of those treated with methotrexate failed to complete follow-up. African-American women and multigravida women were at higher risk of being lost to follow up.