PRACTICE VARIATION IN THE USE OF CORTICOSTEROIDS - A COMPARISON OF 8 DATA SETS

National Institutes of Health (NIH) Consensus Development Conference, Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes, was convened to resolve ongoing uncertainties in the medical community on the benefits of administering corticosteroids to women in prematur e labor. Therapies with uncertain benefits tend to have more varied ra tes of use across small areas than therapies with established benefits .' A recent paper on rates of use of obstetric and neonatal interventi ons confirmed that the use of corticosteroids is highly variable: rate s of use of antenatal corticosteroids for white low birth weight infan ts ranged from near 0% to about 58% across 30 centers participating in the Vermont-Oxford Trials Network in 1990.(2) Although random variati ons in the use of therapies are an indicator of differences in physici an practice styles, consistent variations in rates of use provide indi cators of (1) areas of agreement in use of the therapy across physicia ns and (2) practice contexts that either facilitate or generate obstac les to adoption of the therapy. We examined five of the multicenter da ta sets that were used at the NIH Consensus Conference to assess outco mes of corticosteroid use, along with three additional multicenter dat a sets, to identify consistencies in the pattern of use of antenatal c orticosteroids in premature labor.