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  • Measure Summary
  • NQMC:008644
  • Mar 2013

Management of labor: percentage of patients with preterm labor who received antenatal corticosteroids prior to delivery.

Creedon D, Akkerman D, Atwood L, Bates L, Harper C, Levin A, McCall C, Peterson D, Rose C, Setterlund L, Walkes B, Wingeier R. Management of labor. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 Mar. 66 p. [113 references]

View the original measure documentation External Web Site Policy

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in January 2016.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients with preterm labor who received antenatal corticosteroids prior to delivery.

Rationale

The priority aim addressed by this measure is to increase the percentage of patients with preterm labor (of less than 34 weeks) who receive antenatal corticosteroids.

Antenatal corticosteroid therapy for fetal lung maturation reduces mortality, respiratory distress syndrome and intraventricular hemorrhage in preterm infants. These benefits accrue to preterm neonates across a broad range of gestational ages and are not limited by gender or race. The benefits of the administration of postnatal surfactant are enhanced by antenatal steroid therapy. No adverse consequences to a policy of administration of antenatal steroids to women in preterm labor have been identified.

The beneficial effects of corticosteroids are greatest more than 24 hours after beginning treatment. However, treatment less than 24 hours in duration may improve outcome. Every effort should be made to treat women before spontaneous or elective preterm delivery.

Evidence for Rationale

American College of Clinical Pharmacy. Preterm labor. In: Pharmacotherapy self-assessment program. Module 11: women's health. 3rd ed. Kansas City (KS): American College of Clinical Pharmacy; 2000.

Committee on Obstetric Practice. ACOG committee opinion: antenatal corticosteroid therapy for fetal maturation. Obstet Gynecol. 2002 May;99(5 Pt 1):871-3. PubMed External Web Site Policy

Creedon D, Akkerman D, Atwood L, Bates L, Harper C, Levin A, McCall C, Peterson D, Rose C, Setterlund L, Walkes B, Wingeier R. Management of labor. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 Mar. 66 p. [113 references]

Crowley P. Prophylactic corticosteroids for preterm birth. The Cochrane Library. 2002.

Primary Health Components

Pregnancy; preterm labor; antenatal corticosteroids

Denominator Description

Number of patients in preterm labor (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of patients in preterm labor who received antenatal corticosteroids prior to delivery

State of Use

Current routine use

Current Use

Internal quality improvement

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

IOM Domain

Effectiveness

Case Finding Period

The time frame pertaining to data collection is monthly.

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Institutionalization

Patient/Individual (Consumer) Characteristic

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Number of patients in preterm labor*

Population Definition: All patients giving birth who are in preterm labor.

*Refer to the National Guideline Clearinghouse (NGC) summary of the Institute for Clinical Systems Improvement (ICSI) guideline Management of Labor External Web Site Policy.

Exclusions
Unspecified

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Number of patients in preterm labor who received antenatal corticosteroids prior to delivery

Exclusions
Unspecified

Numerator Search Strategy

Institutionalization

Data Source

Electronic health/medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Percentage of patients with preterm labor who received antenatal corticosteroids prior to delivery.

Measure Collection Name

Management of Labor

Submitter

Institute for Clinical Systems Improvement - Nonprofit Organization

Developer

Institute for Clinical Systems Improvement - Nonprofit Organization

Funding Source(s)

The Institute for Clinical Systems Improvement's (ICSI's) work is funded by the annual dues of the member medical groups and five sponsoring health plans in Minnesota and Wisconsin.

Composition of the Group that Developed the Measure

Work Group Members: Douglas Creedon, MD (Work Group Leader) (Mayo Clinic) (OB/Gyn); Deb Peterson, MD (Affiliated Community Medical Center) (Family Medicine); Lesley Atwood, MD (Allina Medical Clinic) (Family Medicine); Ruth Wingeier, CNM (Central Minnesota Midwifery) (Nurse Midwife); Cherida McCall, CNM (HealthPartners Medical Group and Regions Hospital) (Nurse Midwife); Lori Bates, MD (Mayo Clinic) (Family Medicine); Carl Rose, MD (Mayo Clinic) (Maternal-Fetal Medicine); Becky Walkes, RN (Mayo Clinic) (Nursing); Dale Akkerman, MD (Park Nicollet Health Services) (OB/Gyn); Anna Levin, CNM (Park Nicollet Health Services) (Nurse Midwife); Cindy Harper (Institute for Clinical Systems Improvement) (Systems Improvement Coordinator); Linda Setterlund, MA, CPHQ (Institute for Clinical Systems Improvement) (Clinical Systems Improvement Facilitator)

Financial Disclosures/Other Potential Conflicts of Interest

The Institute for Clinical Systems Improvement (ICSI) has long had a policy of transparency in declaring potential conflicting and competing interests of all individuals who participate in the development, revision and approval of ICSI guidelines and protocols.

In 2010, the ICSI Conflict of Interest Review Committee was established by the Board of Directors to review all disclosures and make recommendations to the board when steps should be taken to mitigate potential conflicts of interest, including recommendations regarding removal of work group members. This committee has adopted the Institute of Medicine Conflict of Interest standards as outlined in the report Clinical Practice Guidelines We Can Trust (2011).

Where there are work group members with identified potential conflicts, these are disclosed and discussed at the initial work group meeting. These members are expected to recuse themselves from related discussions or authorship of related recommendations, as directed by the Conflict of Interest committee or requested by the work group.

The complete ICSI policy regarding Conflicts of Interest is available at the ICSI Web site External Web Site Policy.

Disclosure of Potential Conflicts of Interest

Dale Akkerman, MD (Work Group Member)
OB/GYN Physician, Park Nicollet Health Services
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: State Guideline for Prenatal
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Lesley Atwood, MD (Work Group Member)
Family Medicine Physician, Allina Medical Clinic
National, Regional, Local Committee Affiliations: Allina Pregnancy Care Council
Guideline Related Activities: VBAC guideline task force AAFP
Research Grants: None
Financial/Non-Financial Conflicts of Interest: Expert Testimony for LEEP case

Lori Bates, MD (Work Group Member)
Family Medicine Physician, Mayo Clinic
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Douglas Creedon, MD (Work Group Leader)
OB/GYN Physician, Mayo Clinic
National, Regional, Local Committee Affiliations: None
Guideline Related Activities:
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Anna Levin, CNM (Work Group Member)
Clinical Nurse Midwife, Park Nicollet Health Services
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Cherida McCall, CNM (Work Group Member)
Clinical Nurse Midwife, HealthPartners Medical Group
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Deb Peterson, MD (Work Group Member)
Family Physician, Affiliated Community Medical Center
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Carl Rose, MD (Work Group Member)
Maternal-Fetal Medicine Physician, Mayo Clinic
National, Regional, Local Committee Affiliations: Minnesota ACOG
Guideline Related Activities: None
Research Grants: Sequenom; Cell-free fetal DNA in maternal circulation to detect fetal aneuploidy (concluded 7/29/11)
Financial/Non-Financial Conflicts of Interest: None

Ruth Wingeier, CNM (Work Group Member)
Clinical Nurse Midwife, Central Minnesota Midwifery
National, Regional, Local Committee Affiliations: None
Guideline Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2013 Mar

Measure Maintenance

Scientific documents are revised every 12 to 24 months as indicated by changes in clinical practice and literature.

Date of Next Anticipated Revision

The next scheduled revision will occur within 24 months.

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in January 2016.

Source(s)

Creedon D, Akkerman D, Atwood L, Bates L, Harper C, Levin A, McCall C, Peterson D, Rose C, Setterlund L, Walkes B, Wingeier R. Management of labor. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 Mar. 66 p. [113 references]

Measure Availability

Source available for purchase from the Institute for Clinical Systems Improvement (ICSI) Web site External Web Site Policy. Also available to ICSI members for free at the ICSI Web site External Web Site Policy and to Minnesota health care organizations free by request at the ICSI Web site External Web Site Policy.

For more information, contact ICSI at 8009 34th Avenue South, Suite 1200, Bloomington, MN 55425; Phone: 952-814-7060; Fax: 952-858-9675; Web site: www.icsi.org External Web Site Policy; E-mail: icsi.info@icsi.org.

NQMC Status

This NQMC summary was completed by ECRI Institute on August 30, 2013.

The information was reaffirmed by the measure developer on January 13, 2016.

Copyright Statement

This NQMC summary (abstracted Institute for Clinical Systems Improvement [ICSI] Measure) is based on the original measure, which is subject to the measure developer's copyright restrictions.

The abstracted ICSI Measures contained in this Web site may be downloaded by any individual or organization. If the abstracted ICSI Measures are downloaded by an individual, the individual may not distribute copies to third parties.

If the abstracted ICSI Measures are downloaded by an organization, copies may be distributed to the organization's employees but may not be distributed outside of the organization without the prior written consent of the Institute for Clinical Systems Improvement, Inc.

All other copyright rights in the abstracted ICSI Measures are reserved by the Institute for Clinical Systems Improvement, Inc. The Institute for Clinical Systems Improvement, Inc. assumes no liability for any adaptations or revisions or modifications made to the abstracts of the ICSI Measures.

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NGC GUIDELINE SUMMARIES

  • NGC:009775
  • 2005 Oct (revised 2013 Mar)

Management of labor.


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