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Non-Medically Indicated Delivery Prior to 39 Weeks Gestation in United States Hospitals_Nate DeNicola_ 5_3_13
Non-medically indicated delivery prior to 39 weeks gestationin United States hospitalsNathaniel G. DeNicola, MD; Andrew J. Epstein, PhD; Sindhu K. Srinivas, MD, MSCE Excluded: no L&D unit listed in AHAdatabase, self-reported no L&D unit, or hospitalonly performed emergency deliveries Test/re-test reliability: different caller assignedrandom selection of 10% of original call list Telephone survey with all US L&D units duringan 8 week timeframe: July 1 – August 31, 2012 Script developed from multi-site focusedinterviews with L&D nurses, followed by pilottrial with 10 hospitals: included study disclosure Three callers each assigned random selection of890 hospitals containing 50 states Survey conducted as “cold call” with ChargeNurse or Nurse Manager on L&D to determine ifthe hospital has a specific policy for NMIdelivery < 39 weeksMethods Results The national movement to eliminate NMIdelivery < 39 weeks has prompted manyhospitals to develop specific policies; in ourstudy the majority, 66.5%, reported a policy. Telephone survey via “cold call” to ChargeNurses or Nurse Managers can be an effectivemethod for contacting operational points in thehealth care system: 8% response rate. States with a policy initiative had a significantlyhigher proportion of hospitals reporting aspecific policy against NMI delivery < 39 weeks.Conclusions State initiatives – independently or incoordination with state government –can serve an important role inencouraging hospitals to adopt specificpolicies. Additional studies linking hospital policywith neonatal outcomes could furtherour understanding of hospital policy inadvancing perinatal health. The reality of operational hospitalpolicy may differ from written hospitalpolicy – investigating thiscommunication is an important step inoptimizing the benefit of policy designand implementation.Policy Implications Overall 1,228 Yes-policy hospitals in initiative states (67.8%)vs. 345 Yes-policy hospitals in non-initiative states (62.1%)p<0.012; Highest Yes% among self-reported initiative states:> 1 hospital reported policy initiative in interview p<0.0001. Background. Non-medically indicated (NMI)delivery prior to 39 weeks gestation (<39weeks) is clearly associated with increasedneonatal morbidity. Objectives. To determine the prevalence of UShospital-level policy that specifically addressesNMI delivery <39 weeks. Methods. Telephone survey of all US labor &delivery units to determine presence and typeof hospital policy for NMI delivery < 39 weeks. Results. 2,367 of 2,641 (89.6%) hospitalsresponded: 66.5% “Yes”, 33.5% “No.” Stateswith policy initiatives reported a higherproportion of Yes-policy hospitals: 67.8% v62.1% (p < 0.012). The majority of policy codedas “hard stop” 68.8%. Conclusions. The national movement toeliminate NMI delivery < 39 weeks hasprompted many hospitals to develop specificpolicies. State initiatives represent aneffective approach in policy promotion.Abstract The American College of Obstetricians &Gynecologists (ACOG) has issued guidelinesagainst NMI delivery < 39 weeks; however thepractice continues to occur.Background1. Determine the prevalence of US hospital-levelpolicy that addresses NMI delivery < 39 weeksObjectivesYesHard StopOtherNo“Not Done” *UncertainReviewed bymultipleinvestigatorsResponse Coding* Respondents volunteered thatNMI was against standard of careTest / Re-test ReliabilityTotal hospitals contacted 2,641Respondents 2,367No answer/excluded 274Response Rate 89.6%Comparison Data %Concordance: Yes v No 151 / 214 70.5%Summary of ResponsesYes62%No38%Yes70%No30%Yes62%No38%Self-ReportedInitiative StatesN=1,240 in 18 statesOther States withIdentified InitiativeN=571 in 14 statesNon-Initiative StatesN=556 in 19 states< 45%45% – 65%65% – 80%> 80%Yes66%No34%“Not Done” 53%% Hospitals Reported Yes-Policy“Not Done” 63% “Not Done” 49% “Not Done” 41%