Effect of a Best Practice Alert on Gestational Weight Gain, Health Services, and Pregnancy Outcomes
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Effect of a Best Practice Alert on Gestational Weight Gain, Health Services, and Pregnancy Outcomes Sara M. Lindberg1 • Alexa DeBoth2 • Cynthie K. Anderson3
Ó Springer Science+Business Media New York 2016
Abstract Objective To examine whether an electronic medical record ‘‘best practice alert’’ previously shown to improve antenatal gestational weight gain patient education resulted in downstream effects on service delivery or patient health outcomes. Methods This study involved secondary analysis of data from an intervention to improve provider behavior surrounding gestational weight gain patient education. Data were from retrospective chart reviews of patients who received care either before (N = 333) or after (N = 268) implementation of the intervention. Pre-post comparisons and multivariable logistic regression were used to analyze downstream effects of the intervention on health outcomes and obesityrelated health services while controlling for potential confounders. Results The intervention was associated with an increase in the proportion of prenatal patients who gained weight within Institute of Medicine guidelines, from 28 to 35 % (p \ .05). Mean total gestational weight gain did not change, but variability decreased such that postintervention women had weight gains closer to their gestational weight gain targets. The intervention was associated with a 94 g decrease in mean infant birth weight (p = .03), and an increase in the proportion of overweight
& Sara M. Lindberg [email protected] 1
Population Health Institute, Department of Population Health Sciences, University of Wisconsin - Madison, 610 Walnut St, Madison, WI 53726, USA
2
Center for Women’s Health and Health Disparities Research, Department of Obstetrics and Gynecology, University of Wisconsin - Madison, Madison, WI, USA
3
Department of Obstetrics and Gynecology, University of Wisconsin - Madison, Madison, WI, USA
and obese women screened for undiagnosed Type 2 diabetes before 20 weeks gestation, from 13 to 25 % (p = .01). Conclusions for Practice The electronic medical record can be leveraged to promote healthy gestational weight gain and early screening for undiagnosed Type 2 diabetes. Yet most patients still need additional support to achieve gestational weight gain within Institute of Medicine guidelines. Keywords Obesity Diabetes Prevention Prenatal counseling Electronic health records
Significance What is already known on this subject? Decision support tools in the electronic medical record have been shown to improve provider behavior surrounding gestational weight gain patient education. However, it was unknown whether interventions targeting gestational weight gain patient education could lead to measurable improvement in patients’ actual gestational weight gain, uptake of recommended health services, and related health outcomes. What this study adds? A best practice alert in the electronic medical record promotes healthy gestational weight gain and early screening for undiagnosed Type 2 diabetes.
Introduction The Inst
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