Department of Dietetics and Foodservices, Mater Health, Brisbane, Queensland, 4101, Australia.
Mater Research Institute - University of Queensland, Mothers, Babies and Women's Theme, Brisbane, 4101, Australia.
BMC Pregnancy Childbirth. 2019 Feb 12;19(1):19. doi: 10.1186/s12884-018-2162-x.
Pregnant women who gain weight in accordance with guidelines have the lowest risk of pregnancy and birth-related complications. However, evidence-practice gaps often exist. To address pregnancy weight management barriers, a stepped implementation science approach was used, comprising targeted in-services, provision of scales for clinic rooms, and changes to routine weight recording in a hospital electronic medical record. The aim of this study was to assess the cumulative influence of evidence-based interventions on staff's compliance to recording of antenatal weights.
Retrospective data analysis of weight recording over three 15-month cohorts across April 2014-December 2017. Variables calculated from data included: proportion of women with weight recorded at booking and proportion of women who had a weight recorded at each visit. Generalised estimating equation modelling was used to examine differences in weight recording compliance rates between cohorts, pre-pregnancy body mass index categories, model of care and clinicians.
There were approximately 13,000 pregnancies in each cohort. The proportion of women who had a weight recorded at each visit per cohort differed significantly between cohorts from 4.2% (baseline), 18.9% (scales and in-services) to 61.8% (medical record prompts), p < 0.001.
Significant improvements were achieved through systematic barrier analysis and subsequent mapping and implementation of appropriate and effective interventions. Improvements were observed across the entire service, in all models of care with all professional groups demonstrating increased recording of weights.
按照指南增加体重的孕妇发生与妊娠和分娩相关的并发症的风险最低。然而，证据与实践之间往往存在差距。为了解决妊娠体重管理的障碍，采用了逐步实施科学的方法，包括有针对性的在职培训、为诊室提供秤，以及改变医院电子病历中常规体重记录的方式。本研究旨在评估基于证据的干预措施对工作人员记录产前体重的依从性的累积影响。
对 2014 年 4 月至 2017 年 12 月期间的三个 15 个月队列的体重记录进行回顾性数据分析。从数据中计算出的变量包括：在预约时记录体重的妇女比例和每次就诊时记录体重的妇女比例。使用广义估计方程模型来检查不同队列、孕前体重指数类别、护理模式和临床医生之间的体重记录依从率差异。
每个队列中大约有 13000 次妊娠。每个队列中每次就诊时记录体重的妇女比例在队列之间有显著差异，从 4.2%（基线）、18.9%（秤和在职培训）到 61.8%（病历提示），p<0.001。
通过系统的障碍分析以及随后对适当和有效的干预措施的映射和实施，取得了显著的改善。整个服务都有所改善，所有护理模式和所有专业群体都增加了体重记录。
