Objective: To assess the impact of a clinic-based quality improvement initiative upon aspirin screening and prescription rates for preeclampsia prophylaxis Study Design: Utilizing DMAIC (Define-Measure-Assess-Improve-Control) methodology, key informant interview data were used to identify gaps and potential solutions for suboptimal aspirin screening and prescription. The initiative included provider education on eligibility criteria;workflow changes such as aspirin screening by ancillary staff, automated electronic medical record reminders and inclusion of aspirin screening criteria in clinic note templates;and standardized patient counseling. Patients were included in the analysis if they were >18 years old, English speaking, and < 28 weeks gestation at initial prenatal visit. The primary outcome was aspirin screening rate for new OB patients seen January-June 2021 (post-initiative) compared to September 2019-February 2020 (pre-initiative). We selected a pre-initiative time period remote from the post-initiative period to avoid confounding from workflow changes during the COVID pandemic. Bivariate comparisons assessed demographic differences across groups. Multivariable regression models controlling for race and insurance compared aspirin screening and prescription rates across time periods. Provider literacy was also compared pre- and post-intervention. Results: The 138 patients in the post-initiative group differed in race and insurance status from the 136 patients in the pre-initiative group (Table 1). Screening rate for the post-initiative group was 92.0% vs 62.5% for the pre-initiative group (Table 2;aOR 7.00, 95% CI 3.34-14.67). 85.7% of patients eligible for aspirin received a prescription post-initiative vs 36.8% of patients pre-initiative (aOR 10.13, 95% CI 5.11-20.09). Providers could name more eligibility criteria post-initiative vs pre-initiative (data not shown;5.85 vs 9.77, p< 0.001). Conclusion: This quality improvement initiative significantly augmented aspirin screening and prescription, which can lead to decreased maternal morbidity from preeclampsia. [Formula presented] [Formula presented]
Improving Aspirin Screening and Prescription Rates for Preeclampsia Prevention in an Outpatient Obstetric Clinic