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  • Measure Summary
  • NQMC:008031
  • Jul 2012

Routine prenatal care: percentage of pregnant patients who receive counseling about aneuploidy screening in the first trimester.

Akkerman D, Cleland L, Croft G, Eskuchen K, Heim C, Levine A, Setterlund L, Stark C, Vickers J, Westby E. Routine prenatal care. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2012 Jul. 115 p. [314 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.

Measure Hierarchy

Routine Prenatal Care

Age Group

UMLS Concepts (what is this?)

SNOMEDCT_US
Aneuploidy (80056000), Antenatal care (424525001), Autosomal aneuploidy (428113000), Counseling (129441002), Counseling (409063005), Fetal disorder (70591005), First trimester pregnancy (255246003), First trimester pregnancy (57630001), Pregnancy (289908002)

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 pregnant patients in the clinic panel who are in the course of prenatal care who receive counseling about fetal aneuploidy screening in the first trimester.

Rationale

The priority aim addressed by this measure is to increase the percentage of first-trimester pregnant patients who have documentation of counseling about appropriate aneuploidy screening.

There is near-universal agreement that prenatal care is both beneficial and cost effective. Care designed to help bring healthy babies into the world is regarded as the highest of aspirations. Yet when examined critically, not all prenatal care can be shown to demonstrably improve maternal or neonatal health.

In 1989, the Expert Panel on the Content of Prenatal Care established guidelines on the timing and content of prenatal care, including a schedule consisting of fewer prenatal visits than traditional models provided. This reduced schedule of visits applied to women considered at low risk of adverse perinatal outcomes. Timing and focusing prenatal visits at these intervals, along with providing designated education pieces at each visit, should serve to provide a more comprehensive and satisfying prenatal program than has existed in the past.

Comprehensive counseling should be offered to all pregnant women regarding the different screening options and the benefits and limitations of each of the screening and diagnostic tests. Clinicians counseling patients need to take into consideration a variety of factors, including attitudes toward early first trimester detection, miscarriage, elective termination and having a child with Down syndrome or other birth defects. The estimated risk of miscarriage following amniocentesis or chorionic villus sampling (CVS) has decreased over time. From 1998 to 2003 the adjusted amniocentesis loss rate was 1 in 370. This compares to a previous loss rate of 1 in 200. The decrease in loss rate from CVS has been greater, and there is no longer a statistically significant difference between the two. Patients should be counseled that the rate of miscarriage is low with either amniocentesis or CVS, and there is no preference for one or the other.

Evidence for Rationale

Akkerman D, Cleland L, Croft G, Eskuchen K, Heim C, Levine A, Setterlund L, Stark C, Vickers J, Westby E. Routine prenatal care. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2012 Jul. 115 p. [314 references]

American College of Obstetricians and Gynecologists. In standards for obstetric-gynecologic services. Washington (DC): American College of Obstetricians and Gynecologists; 1989. 16 p.

Berkowitz RL, Cuckle HS, Wapner R, D'Alton ME. Aneuploidy screening: what test should I use. Obstet Gynecol. 2006 Mar;107(3):715-8. PubMed External Web Site Policy

Caughey AB, Hopkins LM, Norton ME. Chorionic villus sampling compared with amniocentesis and the difference in the rate of pregnancy loss. Obstet Gynecol. 2006 Sep;108(3 Pt 1):612-6. PubMed External Web Site Policy

Kuppermann M, Goldberg JD, Nease RF Jr, Washington AE. Who should be offered prenatal diagnosis? The 35-year-old question. Am J Public Health. 1999 Feb;89(2):160-3. [31 references] PubMed External Web Site Policy

Legare F, St-Jacques S, Gagnon S, Njoya M, Brisson M, Fremont P, Rousseau F. Prenatal screening for Down syndrome: a survey of willingness in women and family physicians to engage in shared decision-making. Prenat Diagn. 2011 Apr;31(4):319-26. PubMed External Web Site Policy

Public Health Service Expert Panel on the Content of Prenatal Care. In caring for our future: the content of prenatal care: a report of the PHS expert panel on the content of prenatal care. Washington (DC): 1989.

Primary Health Components

Pregnancy; prenatal care; fetal aneuploidy screening; counseling; education

Denominator Description

Number of women in the clinic panel who are pregnant (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of women who receive counseling and education about aneuploidy screening in the first trimester

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Health and Well-being of Communities
Person- and Family-centered Care
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Staying Healthy

IOM Domain

Effectiveness

Patient-centeredness

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

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Number of women in the clinic panel who are pregnant

Population Definition: All women in the clinic panel who are in the course of prenatal care.

Exclusions
Unspecified

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Number of women who receive counseling and education about aneuploidy screening in the first trimester

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

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 pregnant patients who receive counseling about aneuploidy screening in the first trimester.

Measure Collection Name

Routine Prenatal Care

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: Dale Akkerman, MD (Work Group Leader) (Park Nicollet Health Services) (OB/GYN); Carol Stark, MD (Family HealthServices Minnesota) (Family Medicine); Lori Cleland, CNP (HealthPartners Medical Group and Regions Hospital) (Family Medicine); Georgeanne Croft, CNM (HealthPartners Medical Group and Regions Hospital) (Nurse Midwifery); John Vickers, MD (HealthPartners Medical Group and Regions Hospital) (OB/GYN); Elizabeth Westby, MD (Mayo Clinic) (Family Medicine); Kris Eskuchen, MD (Northwest Family Physicians) (Family Medicine); Anna Levine, CNM (Park Nicollet Health Services) (Nurse Midwifery); Linda Setterlund, MA, CPHQ (Institute for Clinical Systems Improvement) (Clinical Systems Improvement Facilitator); Carla Heim (Institute for Clinical Systems Improvement) (Systems Improvement Facilitator)

Financial Disclosures/Other Potential Conflicts of Interest

Dale Akkerman, MD (Work Group Leader)
Medical Doctor, Ob/Gyn, Park Nicollet Health Services
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: Management of Labor guideline work group, Preventive Services guideline work group
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Lori Cleland, CNP (Work Group Member)
Certified Nurse Practitioner, HealthPartners Medical Group and Regions Hospital
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Georgeanne Croft, CNM, MSN, RN (Work Group Member)
Certified Nurse Midwife, Ob/Gyn, HealthPartners Medical Group and Regions Hospital
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Kris Eskuchen, MD (Work Group Member)
Medical Doctor, Family Medicine, Northwest Family Physicians
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Anna Levine, CNM (Work Group Member)
Certified Nurse Midwife, Ob/Gyn, Park Nicollet Health Services
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: Management of Labor guideline work group
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Carol Stark, MD (Work Group Member)
Medical Doctor, Family Medicine, Family HealthServices Minnesota
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: Committee on Evidence-Based Practice
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

John Vickers, MD (Work Group Member)
Medical Doctor, Ob/Gyn, HealthPartners Medical Group and Regions Hospital
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Elizabeth Westby, MD (Work Group Member)
Medical Doctor, Family Medicine, Mayo Clinic
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

2012 Jul

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)

Akkerman D, Cleland L, Croft G, Eskuchen K, Heim C, Levine A, Setterlund L, Stark C, Vickers J, Westby E. Routine prenatal care. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2012 Jul. 115 p. [314 references]

Measure Availability

Source available from the Institute for Clinical Systems Improvement (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 February 20, 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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