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. 2009 Jul-Aug;22(4):380-6.
doi: 10.3122/jabfm.2009.04.090111.

Improving maternal care with a continuous quality improvement strategy: a report from the Interventions to Minimize Preterm and Low Birth Weight Infants through Continuous Improvement Techniques (IMPLICIT) Network

Ian M Bennett  1 , Andrew Coco, Janice Anderson, Michael Horst, Angela S Gambler, Wendy Brooks Barr, Stephen Ratcliffe
Affiliations

Improving maternal care with a continuous quality improvement strategy: a report from the Interventions to Minimize Preterm and Low Birth Weight Infants through Continuous Improvement Techniques (IMPLICIT) Network

Ian M Bennett et al. J Am Board Fam Med. 2009 Jul-Aug.

Abstract

Background: Maternal medical care (prenatal and postpartum) involves a set of clinical interventions addressing risk factors associated with important maternal and infant outcomes. Programs to increase the rate of delivery of these interventions in clinical practice have not been widely implemented.

Methods: A practice-based research network focused on developing continuous quality improvement (CQI) processes for maternal care among 10 family medicine residency training sites in the northeastern United States (the IMPLICIT Network) from January 2003 through September 2007. Documented delivery of 5 standard maternal care interventions was assessed before and after initiating a program to increase their frequency. Proportion chart analyses were conducted comparing the period before and after implementation of the CQI interventions.

Results: Data were available for 3936 pregnancies during the course of the study period. Results varied across the clinical interventions. Significant improvement in care processes was seen for 3 screening activities: (1) prenatal depression symptomatology (by 15 weeks' gestation); (2) screening for smoking at 30 weeks' gestation; (3) and postpartum contraception planning. Screening for smoking by 15 weeks' gestation and testing for asymptomatic bacteriuria were already conducted >90% of the time during the baseline period and did not increase significantly after initiating the CQI program. Screening for postpartum depression symptomatology was recorded in 50% to 60% of women before the CQI program and did not increase significantly.

Conclusions: A practice-based research network of family medicine residency practices focused on CQI outcomes was successful in increasing the delivery of some maternal care interventions.

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Figures

Figure 1
Figure 1
Study Overview and Conceptual Model for Continuous Quality Improvement Program of Maternal Care Delivery
Figure 2
Figure 2
Proportion of study participants per yearly quarter with documentation of specific prenatal interventions
Figure 3
Figure 3
P charts of smoking cessation screening, contraception planning, and depression screening.
See this image and copyright information in PMC

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