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Learning Objectives for this Presentation:
By the end of the presentation participants will be able to:
Identify factors associated with guideline compliance.
Describe importance of chart documentation.
Discuss the need for improved compliance with standards in perinatal care.
Background:
The Philadelphia birth cohort is comprised largely of groups at-risk for perinatal infections. No city-wide assessment of perinatal screening and vaccination for infectious diseases had been conducted. This study examined compliance with current CDC/ACOG perinatal infectious disease screening standards and identified factors associated with screening in the Philadelphia birth cohort.
Methods:
We selected a stratified random sample of 600 patients representative of the 2000 Philadelphia birth cohort. We reviewed a total of 550 patient records from 14 birthing hospitals. The data were analyzed to determine rates of compliance with the accepted standard of care for prevention of the various diseases and patterns of services and documentation.
Results:
The sample was primarily Black(44%) and Caucasian(34%) with a mean age of 26.3 years, mean gestational age of 38.6 weeks, and 38% Medicaid coverage. Prenatal care was noted in 89% of records of which 85% included the prenatal care chart. Prenatal screening varied by disease: HCV (5%), HIV (52%), GBS (63%), VZV (83%-by history), HBV (92%), rubella (92%), and syphilis (93%). Screening at delivery was reported infrequently HIV (2%), GBS (7.5%), VZV (2%), HBV (6.5%), rubella (7%), and syphilis (67%). Maternal age, race and insurance status were independently associated with screening. Thoroughness of documentation varied widely.
Conclusions:
Compliance with guidelines varies. Rates of screening varied by disease with older screening standards (HBV, rubella, syphilis) followed more than newer standards (GBS, HIV, VZV).Non-standard and incomplete documentation hinders surveillance and quality assurance efforts. Adoption of standard reporting forms could improve practice, increase compliance with guidelines and recommendations and reduce unnecessary morbidity and mortality due to preventable infections.
See more of Poster Session #1
See more of The 2005 National Viral Hepatitis Prevention Conference