A Nudge Toward Universal Aspirin for Preeclampsia Prevention

Ayala, Nina K.; Rouse, Dwight J.

doi:10.1097/aog.0000000000003167

Cited by 30 publications

(25 citation statements)

References 16 publications

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“…A recent expert commentary highlighted the historically poor rate of provider follow through with risk-based screening. 8 Research should not end with positive randomized trials demonstrating clinical benefit. Our study underscores the importance of evaluating the implementation of evidencebased guidelines to ensure patients are actually benefiting from the research conducted.…”

Section: Discussionmentioning

confidence: 99%

“…Historically, study of implementation of guidelines has identified a significant percentage of providers who do not adhere to recommended practices. 6,8 Specifically in OBs, studies have evaluated risk-based screening for gestational diabetes, 11 utilization of progesterone for preterm birth prevention, [12][13][14] and cervical length screening. [15][16][17] These studies have prompted a change in clinical practice to improve adherence (i.e., opt out instead of opt in, as with cervical length screening), 15,18 and removing barriers to progesterone access.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 There has been little published on the implementation of the recent ACOG and USPSTF recommendations regarding aspirin prophylaxis for preeclampsia prevention. 8,9 One recent study from our institution found that only approximately 70% of pregnant patents with a history of chronic hypertension were recommended aspirin following the ACOG recommendations. 10 The objective of this study is how use of a screening tool may improve implementation of ACOG/USPSTF guidelines regarding aspirin use for preeclampsia prevention.…”

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confidence: 99%

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Improving Utilization of Aspirin for Prevention of Preeclampsia in a High-Risk Urban Cohort: A Prospective Cohort Study

et al. 2020

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Objective This study aimed to evaluate the utilization of aspirin for preeclampsia prevention before and after implementation of a screening tool during nuchal translucency (NT) ultrasound. Study Design One-year prospective cohort study of patients at high risk for preeclampsia after the implementation of a screening tool (postscreen) administered to all patients at check in for NT (11–13 weeks) ultrasound. Prospective cohort was compared with one-year retrospective cohort (prescreen) the year prior (2017). All patients who presented for NT ultrasound in both cohorts were evaluated for the presence of one or more risk factor for preeclampsia with screening tool collected prospectively and chart review retrospectively. Provider recommendation for aspirin determined by documentation in prenatal record. Primary outcome was rate of provider recommendation for aspirin pre versus post screening tool, compared by Chi-square test and adjusted for potential confounders with multiple regression analysis. Results Pre- (n = 156) and postscreen (n = 136) cohorts were similar except for race and multifetal gestation. Prescreen, rate of provider recommendation for aspirin was 74%. Of those with prior preeclampsia, 96% were recommended aspirin, compared with 64% of patients with other risk factors (p < 0.001). Postscreen, provider recommendation of aspirin improved to 95% (p < 0.001). Rate of preeclampsia/gestational hypertension were similar between cohorts; however, there was a reduced adjusted risk in overall preterm birth <37 weeks (adjusted odds ratio [aOR] = 0.50 [0.25–0.99]) and preterm birth <34 weeks (aOR = 0.33 [0.13–0.88]) postscreening tool implementation. Conclusion Prior to implementation of a simple screening questionnaire, approximately 25% of high risk patients did not receive the recommendation of aspirin for preeclampsia prevention. High-risk patients who lack a history of preeclampsia were less likely to be advised of aspirin prophylaxis. Use of a simple universal screening tool at time of NT ultrasound significantly improved utilization of aspirin for preeclampsia prevention and may improve patient outcomes. Key Points

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Improving Utilization of Aspirin for Prevention of Preeclampsia in a High-Risk Urban Cohort: A Prospective Cohort Study

et al. 2020

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“…21 Ayala et al also reported that moving from an "opt-in" to an "opt-out" system greatly increased the rate of providing aspirin prophylaxis for preeclampsia prevention. 22 Automated dashboard with active choice and peer comparison performance feedback to physicians had increased statin prescribing for primary care physicians. 23 In our institute, several feasible and low-cost strategies were applied.…”

Section: Discussionmentioning

confidence: 99%

Association of lymph node promotion activity to cervical lymph node yield of oral cancer patients in Asian country: A difference-in-differences analysis

Yang

Kang

Liu

et al. 2020

Preprint

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Objectives: High quality of lymph node yield could increase survival but strategies to improve it was seldom reported. This study was aim to assess the impact of a lymph node promotion activity (LNPA) in oral cancer surgery through a difference-indifferences research design. Design: A retrospective based study. Setting: Medical center in Taiwan. Subjects and methods: A total of 400 oral cancer patients underwent primary tumor resection and neck dissection including elective neck dissection (END) and radical neck dissection (RND) were recruited after propensity score matching by clinical T and N category between 2009 Janu-ary and 2018 October. Oral cancer patients were treated by two independent departments in our institute. Since 2015 Oct, a LNPA was initiated in one department (target group), and another department was as a control group. The impact of LNPA on LN yield and regional recurrence were analyzed and compared between these two groups by difference-indifferences (DID) linear regression analysis. Results: The mean age was 55.2+11.1 years, and 92% were male. 180 (45%) oral cancer patients had T3-4 disease, and 128 (32%) patients had N2-3 disease. In DID analysis, a lower LN yield among the target group before 2015 Oct (coefficient=-11.05, p<0.001). LNPA launched after 2015 Oct in target group showed a positive promotion of LN yield (coefficient=13.24, p<0.001). Moreover, a borderline protective effect of LNPA on regional recurrence among those with cN0 disease (coefficient=-9.4%, p=0.087) was noted. Conclusion: Strategy, like LNPA was associated increased LN yield and decreased regional recurrence in oral cancer. This kind of activity to promote surgeons to improve their quality of neck dissection was feasible and could be applied widespread.

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“…Although this information would be interesting to evaluate we do not think it biases our results as its likely greatest impact would be on reducing our primary outcomes in women with stage 2 hypertension and dampening the increased risk between women with stage 1 and stage 2 hypertension. 9,[17][18][19][20] Finally, almost half of the deliveries that occurred during the study time frame were excluded due to the lack of prenatal records for blood pressure categorization which may have introduced selection bias.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Defining the risk profile of women with stage 1 hypertension: a time to event analysis

Sabol¹,

Porcelli²,

Diveley³

et al. 2021

American Journal of Obstetrics & Gynecology MFM

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A Nudge Toward Universal Aspirin for Preeclampsia Prevention

Cited by 30 publications

References 16 publications

Improving Utilization of Aspirin for Prevention of Preeclampsia in a High-Risk Urban Cohort: A Prospective Cohort Study

Improving Utilization of Aspirin for Prevention of Preeclampsia in a High-Risk Urban Cohort: A Prospective Cohort Study

Association of lymph node promotion activity to cervical lymph node yield of oral cancer patients in Asian country: A difference-in-differences analysis

Defining the risk profile of women with stage 1 hypertension: a time to event analysis

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