NECROSIS FOR MBBS FIRST YEAR STUDENTS MADE EASY.pptx
Non-Medically Indicated Delivery Prior to 39 Weeks Gestation in United States Hospitals_Nate DeNicola_ 5_3_13
1. Non-medically indicated delivery prior to 39 weeks gestation
in United States hospitals
Nathaniel G. DeNicola, MD; Andrew J. Epstein, PhD; Sindhu K. Srinivas, MD, MSCE
Excluded: no L&D unit listed in AHA
database, self-reported no L&D unit, or hospital
only performed emergency deliveries
Test/re-test reliability: different caller assigned
random selection of 10% of original call list
Telephone survey with all US L&D units during
an 8 week timeframe: July 1 – August 31, 2012
Script developed from multi-site focused
interviews with L&D nurses, followed by pilot
trial with 10 hospitals: included study disclosure
Three callers each assigned random selection of
890 hospitals containing 50 states
Survey conducted as “cold call” with Charge
Nurse or Nurse Manager on L&D to determine if
the hospital has a specific policy for NMI
delivery < 39 weeks
Methods Results
The national movement to eliminate NMI
delivery < 39 weeks has prompted many
hospitals to develop specific policies; in our
study the majority, 66.5%, reported a policy.
Telephone survey via “cold call” to Charge
Nurses or Nurse Managers can be an effective
method for contacting operational points in the
health care system: 8% response rate.
States with a policy initiative had a significantly
higher proportion of hospitals reporting a
specific policy against NMI delivery < 39 weeks.
Conclusions
State initiatives – independently or in
coordination with state government –
can serve an important role in
encouraging hospitals to adopt specific
policies.
Additional studies linking hospital policy
with neonatal outcomes could further
our understanding of hospital policy in
advancing perinatal health.
The reality of operational hospital
policy may differ from written hospital
policy – investigating this
communication is an important step in
optimizing the benefit of policy design
and 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 (<39
weeks) is clearly associated with increased
neonatal morbidity.
Objectives. To determine the prevalence of US
hospital-level policy that specifically addresses
NMI delivery <39 weeks.
Methods. Telephone survey of all US labor &
delivery units to determine presence and type
of hospital policy for NMI delivery < 39 weeks.
Results. 2,367 of 2,641 (89.6%) hospitals
responded: 66.5% “Yes”, 33.5% “No.” States
with policy initiatives reported a higher
proportion of Yes-policy hospitals: 67.8% v
62.1% (p < 0.012). The majority of policy coded
as “hard stop” 68.8%.
Conclusions. The national movement to
eliminate NMI delivery < 39 weeks has
prompted many hospitals to develop specific
policies. State initiatives represent an
effective approach in policy promotion.
Abstract
The American College of Obstetricians &
Gynecologists (ACOG) has issued guidelines
against NMI delivery < 39 weeks; however the
practice continues to occur.
Background
1. Determine the prevalence of US hospital-level
policy that addresses NMI delivery < 39 weeks
Objectives
Yes
Hard Stop
Other
No
“Not Done” *
Uncertain
Reviewed by
multiple
investigators
Response Coding
* Respondents volunteered that
NMI was against standard of care
Test / Re-test Reliability
Total hospitals contacted 2,641
Respondents 2,367
No answer/excluded 274
Response Rate 89.6%
Comparison Data %
Concordance: Yes v No 151 / 214 70.5%
Summary of Responses
Yes
62%
No
38%
Yes
70%
No
30%
Yes
62%
No
38%
Self-Reported
Initiative States
N=1,240 in 18 states
Other States with
Identified Initiative
N=571 in 14 states
Non-
Initiative States
N=556 in 19 states
< 45%
45% – 65%
65% – 80%
> 80%
Yes
66%
No
34%
“Not Done” 53%
% Hospitals Reported Yes-Policy
“Not Done” 63% “Not Done” 49% “Not Done” 41%