Methods to encourage the use of antenatal corticosteroid therapy for fetalmaturation - A randomized controlled trial

Context Antenatal corticosteroids for fetal maturation have been underused, despite evidence for their benefits in cases of preterm birth. Objective To evaluate dissemination strategies aimed at increasing appropri ate use of this therapy. Design and Setting Twenty-seven tertiary care institutions were randomly as signed to either usual dissemination of practice recommendations (n = 14) o r usual dissemination plus an active, focused dissemination effort (n = 13) , Subjects Obstetricians and their preterm delivery cases at participating ho spitals. Intervention Recommendations by a National Institutes of Health (NIH) Conse nsus Conference held in late February-early March 1994 were disseminated in early May 1994. Usual dissemination was publication of the recommendations and endorsement by the American College of Obstetricians and Gynecologists . Active dissemination was a year-long educational effort led by an influen tial physician and a nurse coordinator at each facility, consisting of gran d rounds, a chart reminder system, group discussion of case scenarios, moni toring, and feedback. Main Outcome Measure Use or nonuse of antenatal corticosteroids was abstrac ted from medical records of eligible women delivering at the participating hospitals in the 12 months immediately prior to release of the NIH recommen dations (average number of records abstracted, 130) and in the 12 months fo llowing their release (average number of records abstracted, 122). Results Active dissemination significantly increased the odds of corticoste roid use after the conference. Use increased from 33.0% of eligible patient s receiving corticosteroids to 57.6%, or by 75% over baseline, in usual dis semination hospitals. Use increased from 32.9% to 68.3%, or an 108% increas e, in active dissemination hospitals. Gestational age and maternal diagnosi s affected use of the therapy in complex ways. Conclusion An active, focused dissemination effort increased the effectiven ess of usual dissemination methods when combined with key principles to cha nge physician practices.