480: Perinatal core measure: antenatal steroid performance improvement following a preterm birth risk assessment decision model and perinatal QI toolkit

Antenatal steroid (ANS) exposure is an emerging national perinatal care core safety measure. We report ANS performance at a large tertiary level perinatal center after a collaborative quality improvement (QI) effort that included an antenatal management decision model and process improvement using a California-wide perinatal QI toolkit. The California Perinatal Quality Care Collaborative (CPQCC) network defines this measure as the percent of delivered premature infants (401-1500 grams and 24+0 to 33+6 weeks) whose mothers had received ANS. A QI initiative was implemented at our institution in 2006 after benchmarking ANS performance in 2005. OB triage care was standardized with an evidence based decision model and order set to identify ANS candidates between 24 and 34 weeks gestation using published ACOG criteria. For women with symptomatic contractions, the decision model used clinical findings and fetal fibronectin (fFN) to determine management. Women meeting preterm birth (PTB) risk criteria including fFN positive testing received an initial course of ANS. Women who did not meet PTB risk criteria (eg stable cervix with negative fFN) did not receive ANS and were not admitted, even if persistent uterine activity. QI activities also included a state-wide perinatal ANS toolkit to improve processes of documentation and data collection. During the five year study period (2005-2009), there were 27,737 births and 60,015 total OB triage evaluations for all indications including PTB risk assessment decision model to determine ANS administration. Performance of state quality measure for ANS administration at our center increased significantly between 2005 baseline and the 2009 assessment of decision model and QI toolkit (77.1% vs 100%, p<0.01). Our center performance was significantly higher than mean state system-wide performance (p<0.01). Quality Improvement initiatives including evidence based decision models to standardize management and the use of perinatal tool kits can improve performance of Perinatal Core measure ANS administration.