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Related Experiment Videos

Variation in antenatal testing over time and between clinic settings.

J L Read, R S Stern, L A Thibodeau

    JAMA
    |March 25, 1983
    PubMed
    Summary

    Diagnostic procedure use varied by patient and physician factors. Ultrasound and antepartum fetal heart rate testing (AFHRT) utilization increased, while 24-hour urinary estriol levels (EST) remained constant during the study period.

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    Area of Science:

    • Obstetrics and Gynecology
    • Medical Diagnostics
    • Health Services Research

    Background:

    • Variation in diagnostic procedure use is influenced by patient, physician, and environmental factors.
    • Understanding trends in diagnostic testing is crucial for optimizing obstetric care.
    • Previous research has not fully elucidated the specific trends for key antepartum tests.

    Purpose of the Study:

    • To examine the utilization trends of three key diagnostic procedures in obstetrics: 24-hour urinary estriol levels (EST), diagnostic ultrasound, and antepartum fetal heart rate testing (AFHRT).
    • To identify factors associated with the observed changes in testing rates over time.

    Main Methods:

    • Retrospective analysis of 8,527 deliveries between 1975 and 1978.
    • Stratification of patients using a multivariate confounder score based on 45 clinical variables.

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  • Comparison of testing rates across different antenatal care settings (hospital-based group practice, community clinic, private offices, prepaid group practice).

    • Main Results:

    • Utilization of 24-hour urinary estriol levels (EST) remained stable at approximately 7%.
    • Diagnostic ultrasound utilization increased from 20% to 35% over the study period.
    • Antepartum fetal heart rate testing (AFHRT) increased from 7% to 12% during the same timeframe.
    • Increased testing rates persisted even after adjusting for patient confounders.
    • Patients receiving antenatal care in hospital-based group practices or resident-staffed community clinics were more likely to undergo testing compared to those in private offices or prepaid group practices.

    Conclusions:

    • Diagnostic ultrasound and AFHRT experienced significant increases in utilization during the 1970s, independent of patient characteristics.
    • The setting of antenatal care significantly influences the likelihood of utilizing these diagnostic procedures.
    • These findings highlight evolving practices in obstetric diagnostics and the impact of healthcare delivery models on test utilization.