Objective: To examine the effectiveness of a comprehensive office systems i
ntervention for improving identification of diethylstilbestrol (DES) exposu
re, a low-incidence condition with potentially severe consequences.
Methods: We developed a comprehensive office systems intervention to facili
tate screening and follow-up for women exposed to DES in utero, consisting
of a DES toolkit and the clinical and administrative education necessary to
use the tools effectively The intervention was implemented in the internal
medicine and obstetrics-gynecology departments at six free-standing health
centers in a Boston-area staff-model health maintenance organization. Inte
rvention sites were matched and paired with a comparison group of centers.
Intervention effectiveness was assessed through pretest and posttest survey
s of clinicians, medical record review of: 3900 women, and review of a comp
uterized medical records data base.
Results: There was significantly higher DES awareness and knowledge among c
linical staff at intervention sites. Documentation of DES exposure in the m
edical record ranged from 1.14 to 2.31 times greater at intervention sites
than in matched comparison sites, and rates of DES code use in pregnancy we
re 1.91 to 3.61 times greater.
Conclusions: The office systems intervention improved documentation of DES
exposure in a managed care environment. Because this approach was designed
to accommodate the limited time allotted for each patient visit, it not onl
y improved DES screening hut could also serve as a model for integrating sc
reening for other low-prevalence but potentially serious conditions into ro
utine care. (Obstet Gynecol 2000;96:380-4. (C) 2000 by The American College
of Obstetricians and Gynecologists).