Batra Priya, Hirai Ashley, Selk Sabrina, Lee Vanessa, Lu Michael
School of Medicine, Center for Healthy Communities, University of California, 900 University Avenue, Riverside, CA, 92521, USA.
Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD, USA.
Matern Child Health J. 2017 Mar;21(3):446-451. doi: 10.1007/s10995-016-2234-3.
Introduction Despite strong evidence supporting the benefit of 17-alpha hydroxyprogesterone caproate (17P) in preventing recurrent preterm birth, this treatment still does not reach most eligible patients. This study sought to identify approaches to measuring the appropriate use of 17P, with the goal of helping health systems better monitor and improve the implementation of this intervention. Methods Semi-structured telephone interviews were used to gather data on measures for 17P use being developed and implemented by state team members participating in the Infant Mortality Collaborative Improvement and Innovation Network (IM CoIIN)-a national quality improvement initiative. Strengths and limitations of these measurement approaches were described. Results Six approaches to measuring 17P use to prevent preterm birth were identified: practice-level data, population-based surveys, three measures employing insurance claims with or without linked birth certificate data, and revised birth certificates. Each measure had particular strengths and limitations. Practice-level measures were useful in rapid-cycle improvement, but were not generalizable across sites. In contrast, population-based measures (i.e., surveys, claims) were useful for broad comparisons, but were limited in their timeliness, and in how accurately they identified candidates who were truly eligible for 17P. Additionally, such measures required complex data linkage and analytic capabilities. Discussion A variety of imperfect measures for the appropriate use of 17P are available. No "best" measure was identified-the optimal measurement option must fit the specific needs of a health agency. Better data infrastructure and harnessing information from integrated electronic health records could improve the quality of 17P use measurement for improvement efforts.
引言 尽管有强有力的证据支持己酸17-α羟孕酮（17P）在预防复发性早产方面的益处，但这种治疗方法仍未惠及大多数符合条件的患者。本研究旨在确定衡量17P合理使用的方法，目标是帮助卫生系统更好地监测和改进这种干预措施的实施情况。方法 采用半结构化电话访谈收集参与婴儿死亡率协作改进与创新网络（IM CoIIN，一项全国性质量改进计划）的州团队成员正在制定和实施的17P使用衡量措施的数据。描述了这些测量方法的优点和局限性。结果 确定了六种用于衡量预防早产的17P使用情况的方法：实践层面的数据、基于人群的调查、三种使用保险理赔并带有或不带有关联出生证明数据的措施，以及修订后的出生证明。每种方法都有其特定的优点和局限性。实践层面的措施在快速循环改进中很有用，但不能在各地点推广。相比之下，基于人群的措施（即调查、理赔）有助于进行广泛比较，但在及时性以及准确识别真正符合17P使用条件的候选人方面存在局限性。此外，这些措施需要复杂的数据关联和分析能力。讨论 对于17P的合理使用，有多种不完善的测量方法。未确定“最佳”方法——最佳测量选项必须符合卫生机构的特定需求。更好的数据基础设施以及利用综合电子健康记录中的信息可以提高用于改进工作的17P使用测量的质量。
