Office systems intervention to improve diethylstilbestrol screening in managed care

Citation
R. Jackson et al., Office systems intervention to improve diethylstilbestrol screening in managed care, OBSTET GYN, 96(3), 2000, pp. 380-384
Citations number
18
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Reproductive Medicine","da verificare
Journal title
OBSTETRICS AND GYNECOLOGY
ISSN journal
0029-7844 → ACNP
Volume
96
Issue
3
Year of publication
2000
Pages
380 - 384
Database
ISI
SICI code
0029-7844(200009)96:3<380:OSITID>2.0.ZU;2-#
Abstract
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).