Mobilizing Group B Strep Prevention -- GBS App for Obstetric and Neonatal Guidance

Background:  Group B Streptococcus (GBS) is the leading cause of early-onset neonatal sepsis in the US. CDC published guidelines for the prevention of early onset group B streptococcal disease (EOGBS) in 1996 and updated the guidelines in 2002 and 2010. However, assessing the uptake of the guidelines, CDC found adherence to prenatal screening and antibiotic treatment for infected women during the birthing process was less than ideal. Additionally, CDC found that more than half of surveyed hospitals had policies for evaluation and management of newborns at risk for EOGBS disease that were not consistent with CDC’s guidelines.

Program background:  While CDC’s GBS prevention guidelines are available in print and online, they are relatively cumbersome. They require physicians to review 36 pages and 5 flowcharts with intricate footnotes that may be difficult to interpret, especially when physicians are in urgent situations requiring prompt treatment decisions. We envisioned a mobile tool that could provide quick, timely access for obstetricians and neonatologists and deliver specific recommendations for specific patient scenarios. This web-based tool, called the GBSApp, would allow users to input patient characteristics. Their yes/no clicks to screen prompts would yield specific recommendations based on the guidelines. The application would be available on CDC’s mobile website, optimized for smartphones and PDAs, and as a stand-alone native application for iOS and Android devices. We hypothesized that free, quick access to the tool would improve physicians’ understanding of EOGBS disease, increase appropriate antibiotic treatment of infected women during the birth process, improve evaluation of newborns at risk for EOGBS disease, and potentially save babies’ lives. 

Evaluation Methods and Results:  Identifying that the treatment algorithms could be restated as questions with yes/no answers, we worked with subject matter experts to build logic trees for various patient scenarios. Our programmer built the tool, with separate decision paths for neonatologists and obstetricians. CDC experts tested and refined the tool before soliciting beta testing by clinicians. Feedback from the testers informed additional refinement. The mobile site was introduced, with web metrics quantifying usage. Users are offered but not required to complete a survey. The iPhone/iPad/Android tablet application will be released in late summer. Because updates to the guidelines occur rarely, we will probably need to update the technology platform before we must update the medical science it supports. Yet we are committed to semi-annually assessing the usability of the tool.

Conclusions:  With the widespread adoption of mobile devices and the growth of physician-targeted apps, we are pleased to offer an evidence-based mobile tool that can improve implementation of CDC's GBS guidelines and may help prevent EOGBS disease. Complicated algorithms support a simple interface that, through a series of simple questions, can deliver evidence-based recommendations to harried clinicians.

Implications for research and/or practice:  The GBSApp is intended to serve as a supplement or aid to clinical judgment. But in that aid, it will, we believe, simplify and improve the clinicians’ care of GBS-infected pregnant women and their at-risk babies.