Improving the Quality of Prenatal Care at the WMed FM Residency Clinic Susan Jevert, DO Homer Stryker MD School of Medicine Department of Family and Community.

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Presentation transcript:

Improving the Quality of Prenatal Care at the WMed FM Residency Clinic Susan Jevert, DO Homer Stryker MD School of Medicine Department of Family and Community Medicine Kalamazoo, MI

Disclosures I have no conflicts to disclose

Objectives On completion of this session, the participants should be able to: –Understand how to implement standardized OB care into their clinic and apply this to other areas of care –Understand ACGME scholarly activity requirement –Identify possible areas for quality improvement within their program –Identify ways to motivate students & residents to participate in quality improvement

Our Clinic Western Michigan University Homer Stryker MD Family Medicine Residency Clinic (WMed) is housed in a federally qualified health center (FQHC) The safety net for medical care, including obstetrical care, in Kalamazoo County

Our Patients

Hypothesis The quality of prenatal care provided in our resident clinic can be improved through standardization of care and quarterly physician feedback.

Methods Design : Cohort study in which adherence to the current obstetrical standards of care was considered

Methods Protocol: –A standardized "check list” of 22 areas of prenatal screening and education was developed based on current ACOG, AAFP and CDC guidelines –Completed chart reviews of OB patients who received prenatal care in our clinic between July, 2012 and December, 2014, who met our inclusion criteria, to establish baseline data –Trained providers on our prenatal care "check list” –Collected data for one year after the “check list” was implemented based on completion rates of the various elements of OB screening and education

Methods Inclusion criteria: –Patients who established for prenatal care and delivered with Team Oakland –Patients who did not receive prenatal care elsewhere after establishing with Team Oakland –169 patients met our inclusion criteria for the retrospective portion and 130 for the implementation phase

Methods Exclusion criteria –Patients who transferred care prior to delivery –Any testing or education indicated per guidelines before the patient established care with Team Oakland were not taken into consideration

Methods Statistical analysis: Compared pre and post implementation data using Chi-Square test of independence and Fishers exact test

Results Statistically significant improvement in 8 of 22 areas of prenatal screening and education Overall improvement from 58.66% to 72.2%

Pre-InterventionPost-InterventionDifferenceP Value NPercentageN Overall % %+13.55%< PHQ9 Screening at 1 st visit % %+20.92%< OB 1st visit % %+0.00% 1 Gonorrhea & Chlamydia 1st visit % %+5.16% Test of Cure for Chlamydia % %+21.72% Offered HIV 1st visit % %+4.33% PAP Screening if 1st visit % %+1.30% Urine 1st visit or 12-16wks % %+15.53% Offered Quad 15-20wks % %+4.94% Offered Anatomy 18-21wks % %+10.40% Repeat 24-28wks % %+6.64% hr 24-28wks % %+3.91% hr GTT if needed % %+1.95% weeks666.67% % Repeat antibody screen prior to Rhogam633.33% % Repeat Chlamydia (3rd trimester if high risk) % %+38.19% Repeat HIV (3rd trimester if high risk)160% %+61.11% GBS 35-37wks % %-1.33% Complete 1st trimester education %7835.9%+9.13% Complete 2nd trimester education % %+37.47% < Complete 3rd trimester education % %+37.83% < Tdap 27-36wks % %+20.24% Flu vaccine % %+21.07%

Results Figure 4. Comparison of pre and post compliance rates.

Conclusion We proved our hypothesis by demonstrating an improvement in the quality of prenatal care provided in our clinic through standardization of care and quarterly physician feedback

Limitations and Barriers to Success Patient non-compliance with keeping scheduled appointments Resident buy-in with the checklist Small sample sizes for several measures

Ideas Standardization of pediatric well child visit Standardization of diabetic care MA/Resident communication forms OB patient scheduling/call schedule

Scholarly Activity The curriculum must advance residents’ knowledge of the basic principles of research, including how research is conducted, evaluated, explained to patients, and applied to patient care Residents should complete 2 scholarly activities, at least one of which should be a quality improvement project

“I don’t care about research”

Quality Improvement Projects Easy to get IRB approval/exemption Allows residents to have a say if how things are done

Tips for Success Help them find something they are passionate about Teach PDSA cycles Know your resources Use your faculty advisors Offer resident incentive for presenting at a conference

Acknowledgments We would like to thank the Western Michigan University Homer Stryker MD School of Medicine Department of Family Medicine and the Department of Epidemiology and Biostatistics for their assistance with this project. This study was approved as exempt on December 8, 2014 by the IRB committee at Bronson Methodist Hospital.

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