Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
Harvard Medical School, Boston, Massachusetts, United States of America.
PLoS One. 2024 Jul 29;19(7):e0303930. doi: 10.1371/journal.pone.0303930. eCollection 2024.
To assess the feasibility of integrating a pregnancy intention assessment screening algorithm into the electronic medical record (EMR) at a multispecialty clinic focused on the health of women and people assigned female at birth (AFAB).
This pilot quality improvement project implemented a series of clinician reminders, new data fields in the patient record, and templated clinical notes to prompt care providers across specialties to ask AFAB reproductive age individuals about their desire for future pregnancies. Investigators created a novel screening question based on prior literature and expert input. Prospective observational study of one year of during-intervention EMR data on screening uptake and documentation, contraceptive use, and referrals to obstetrics and gynecology (OBGYN) for preconception care, contraceptive care, and related services.
SUPPORT launched in February 2020 and was paused for 6 months due to the COVID-19 pandemic. During the intervention period through July 2021, 18% of patients for whom the automated screening reminder was activated had a documented pregnancy intention. Patients were screened in OBGYN, internal medicine, and eight subspecialty medical clinics. Among those screened, individuals who reported they did not desire pregnancy in the next year were more likely to use contraception (aOR 1.8, 95% CI 1.1, 3.1). Individuals that did desire pregnancy in the next year were more likely to be subsequently referred to OBGYN (aOR 2.7, 95% CI 1.2, 6.0).
Despite the competing demands of the COVID-19 pandemic, the SUPPORT intervention was utilized at higher rates than prior similar interventions and across multiple disease specialties.
Results from the SUPPORT pilot suggest that pregnancy intention screening of reproductive age AFAB individuals with an EMR-based screening prompt is feasible at scale.
评估在一个专注于女性和出生时被指定为女性的人的健康的多专科诊所将妊娠意向评估筛查算法整合到电子病历（EMR）中的可行性。
本试点质量改进项目实施了一系列临床医生提醒、患者记录中的新数据字段和模板化临床记录，以提示跨专业的医疗服务提供者询问生育年龄的 AFAB 个体对未来妊娠的期望。研究人员根据先前的文献和专家意见创建了一个新的筛查问题。对一年期间干预期间 EMR 数据的前瞻性观察研究，包括筛查率和记录、避孕措施以及转诊到妇产科（OBGYN）进行孕前保健、避孕护理和相关服务。
SUPPORT 于 2020 年 2 月启动，并因 COVID-19 大流行暂停了 6 个月。在干预期间（截至 2021 年 7 月），18%的自动筛查提醒激活患者有记录的妊娠意向。患者在 OBGYN、内科和八个专科医疗诊所接受了筛查。在接受筛查的人群中，报告在未来一年内不想要怀孕的个体更有可能使用避孕措施（aOR 1.8，95%CI 1.1，3.1）。在未来一年内有怀孕意向的个体更有可能随后被转诊到 OBGYN（aOR 2.7，95%CI 1.2，6.0）。
尽管受到 COVID-19 大流行的竞争需求的影响，但 SUPPORT 干预的利用率高于先前类似的干预措施，并在多个疾病专科中得到应用。
SUPPORT 试点研究的结果表明，通过 EMR 为基础的筛查提示对生育年龄的 AFAB 个体进行妊娠意向筛查在大规模上是可行的。
