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Utilization patterns of cord blood gas analysis
A K Skelton1, M P Madan, W D Thompson
1Department of Family Practice, Maine Medical Center, Portland, USA. skelta@mail.mmc.org
Obstetrics and Gynecology
|November 5, 1997
Summary
Cord blood gas analysis use varied significantly between hospitals, with most tests performed against guidelines. Institutional factors, not patient characteristics, predicted test use, indicating a need for revised practices.
Area of Science:
- Perinatal medicine
- Clinical practice patterns
- Healthcare quality improvement
Background:
- Cord blood gas analysis is a tool used to assess neonatal acid-base status at birth.
- Variations in clinical practice can impact resource utilization and patient care.
Purpose of the Study:
- To examine cord blood gas analysis utilization in two Portland, Maine hospitals.
- To identify predictors of test use.
- To assess adherence to American College of Obstetricians and Gynecologists (ACOG) guidelines.
Main Methods:
- Retrospective review of billing data from 3166 deliveries in 1994.
- Merging billing data with birth certificate data to analyze associated factors.
- Comparison of test utilization with ACOG guidelines.
Main Results:
- A 20-fold difference in test use was observed between the tertiary care center (49% of births) and the community hospital (2.5% of births).
- Institutional factors, particularly the hospital, were stronger predictors of test use than maternal or neonatal factors.
- 97% of tests were performed in situations not supported by ACOG recommendations, indicating poor guideline adherence.
Conclusions:
- Current cord blood gas analysis use is inconsistent with guidelines and inefficient.
- Institutional practices significantly influence test utilization.
- Examination and modification of institutional factors driving excess testing are recommended.