Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC.
Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC.
Am J Obstet Gynecol. 2016 Jul;215(1):105.e1-105.e12. doi: 10.1016/j.ajog.2016.01.180. Epub 2016 Jan 29.
Although a weekly injection of 17-hydroxyprogestone caproate is recommended for preventing recurrent preterm birth, clinical experience in North Carolina suggested that many eligible patients were not receiving the intervention.
Our study sought to assess how well practices delivering at 2 major hospitals were doing in providing access to 17-hydroxyprogesterone caproate treatment for eligible patients.
This retrospective cohort analysis studied all deliveries occurring between January 1, 2012, and December 31, 2013, at 2 large hospitals in North Carolina. Women were included if they had a singleton pregnancy and history of a prior spontaneous preterm birth. We extracted demographic, payer, and medical information on each pregnancy, including whether women had been offered, accepted, and received 17-hydroxyprogesterone caproate. Our outcome of 17-hydroxyprogesterone caproate coverage was defined as documentation of ≥1 injection of the drug.
Over the 2-year study period, 1216 women with history of a prior preterm birth delivered at the 2 study hospitals, of which 627 were eligible for 17-hydroxyprogesterone caproate eligible after medical record review. Only 296 of the 627 eligible women (47%; 95% confidence interval, 43-51%) received ≥1 dose of the drug. In multivariable analysis, hospital of delivery, later presentation for prenatal care, fewer prenatal visits, later gestation of prior preterm birth, and having had a term delivery immediately before the index pregnancy were all associated with failed coverage. Among those women who were "covered," the median number of 17-hydroxyprogesterone caproate injections was 9 (interquartile range, 4-15), with 84 of 296 charts (28%) not having complete information on the number of doses.
Even under our liberal definition of coverage, less than half of eligible women received 17-hydroxyprogesterone caproate in this sample. Low overall use suggests that there is opportunity for improvement. Quality improvement strategies, including population-based measurement of 17-hydroxyprogesterone caproate coverage, are needed to fully implement this evidence-based intervention to decrease preterm birth.
虽然建议每周注射 17-羟孕酮己酸酯以预防复发性早产，但北卡罗来纳州的临床经验表明，许多符合条件的患者并未接受该干预措施。
我们的研究旨在评估两家主要医院在为符合条件的患者提供 17-羟孕酮己酸酯治疗方面的实践情况。
这项回顾性队列分析研究了 2012 年 1 月 1 日至 2013 年 12 月 31 日期间在北卡罗来纳州两家大型医院发生的所有分娩。如果女性怀有单胎妊娠且有先前自发性早产史，则将其纳入研究。我们提取了每位孕妇的人口统计学、支付方和医疗信息，包括女性是否被提供、接受和接受 17-羟孕酮己酸酯治疗。我们将 17-羟孕酮己酸酯的覆盖率定义为记录至少接受 1 次药物注射。
在 2 年的研究期间，有 1216 名有早产史的女性在这两家研究医院分娩，其中 627 名在病历审查后符合 17-羟孕酮己酸酯的使用条件。在 627 名符合条件的女性中，只有 296 名（47%；95%置信区间，43-51%）接受了至少 1 剂药物。多变量分析显示，分娩医院、产前保健就诊较晚、产前就诊次数较少、先前早产的孕龄较晚以及在本次妊娠前有足月分娩史，这些因素都与覆盖率失败有关。在那些被“覆盖”的女性中，17-羟孕酮己酸酯的中位数注射次数为 9 次（四分位距，4-15 次），296 份病历中有 84 份（28%）未完整记录剂量数。
即使按照我们宽松的覆盖率定义，在这个样本中，仍有不到一半的符合条件的女性接受了 17-羟孕酮己酸酯治疗。总体使用率较低表明仍有改进的空间。需要实施包括基于人群的 17-羟孕酮己酸酯覆盖率测量在内的质量改进策略，以充分实施这一基于证据的干预措施，降低早产率。
