UTILIZATION PATTERNS OF CORD-BLOOD GAS-ANALYSIS

Objective: To determine patterns of use of cord blood gas analysis in two institutions in Portland, Maine; to determine which factors, if an y, predicted use of:he test. and to evaluate compliance with ACOG guid elines. Methods: Billing data were used from 3166 deliveries during 19 94 in the two hospitals to find deliveries in which the test was perfo rmed. We merged billing data with birth certificate data to examine fa ctors associated with the test's use. Finally, we compared its use in our community with recently updated ACOG guidelines. Results: There wa s a 20-fold difference in the test's use between institutions (P < .00 1). The Lest was performed in 49% of all births at the tertiary care c enter and 2.5% of births at the community hospital. Many maternal and neonatal factors were linked to use of the test, but delivery system f actors, in particular, the institution, were the strongest predictors of the Lest's use, even controlling for confounding factors between ho spitals. There was little adherence to ACOG guidelines, with 97% of th e tests being performed in situations in which ACOG's recommendations did not support use of the analysis. Conclusion: Current use of cord b lood gas analysis in our community is not consistent with guidelines o r cost-effective use of resources; the institutional factors that dete rmine excess use should be examined and modified. (C) 1997 by The Amer ican College of Obstetricians and Gynecologists.