Implementation of a Screening Guideline for and Multidsciplinary Clinic Care of Pregnant Women with Underlying Cardiac Disease in an Urban Academic Healthcare System
Introduction: Pregnancy-related maternal mortality is rising in the United States, with the most common underlying etiology now cardiac and hypertensive disease. Health care decisions in the diagnosis and treatment of cardiovascular disease have likewise been linked to maternal mortality. Implementation of a cardio-obstetrics program, including a guideline and multidisciplinary clinic, may standardize and optimize care. Methods: This study used a combination of retrospective and prospective cohorts as well as cross-sectional surveys of providers and patients to assess the implementation of the cardio-obstetrics program at Thomas Jefferson University. Prevalence of resting heart rates recorded for return prenatal care visits pre- and post-implementation of a guideline in January 2020 were compared. Staff perspective regarding implementation of the cardio-obstetrics program was solicited with a survey grounded in the Consolidated Framework for Implementation Research (CFIR) model. Patient experience with the multidisciplinary clinic started in March 2021 (consultations with both cardiology and maternal-fetal medicine (MFM) simultaneously) was captured using validated and published surveys, including the Patient Feedback on Consultation Skills (PFC) questionnaire. Utilization of transthoracic echo to screen for underlying heart disease in asymptomatic women at high risk for cardiac disease was assessed pre- and post-guideline implementation. Prevalence of clinically significant pathology was noted was well as cardiac and obstetric outcomes. Results: Prior to implementation of the guideline, 257 out of 1200 (21.4%) return prenatal visits had a resting heart rate routinely obtained during prenatal care. This was significantly different after implementation of the guideline (1541 out of 2278, 67.6%, p < 0.001). Staff members identified characteristics of individuals as potential domains of success during implementation. Among asymptomatic women obtaining consultations with maternal fetal medicine, women were much more likely to be recommended for a transthoracic echo post-guideline compared to pre-guideline (64 out of 80, 80.0%, versus 32 out of 91, 35.2%, respectively, p < 0.001). Women were more likely to complete their transthoracic echocardiography screening post-guideline compared to pre-guideline (63 of 80, 78.8% versus 45 of 91, 49.5%, respectively, p < 0.001). Of those who completed the echo, 31 out 108 (28.7%) had pathology identified on the screening echo. Among those seen in the cardio-obstetrics clinic, most agreed or strongly agreed that this clinic was more convenient (30 out of 32, 93.7%), more satisfying (31 out of 33, 93.9%), and more informative (28 out of 32, 87.5%). Obstetric and cardiac outcomes were not statistically different pre- versus post-guideline. Conclusion: This study shows significant improvements in prevalence of heart rate screening and completion of transthoracic echocardiography after implementation of a cardio-obstetrics program. Staff and patients had overall positive experiences with implementation of this program. Additional adequately-powered prospective studies are needed to confirm improved patient outcomes.
Health sciences|Health care management|Obstetrics
McCurdy, Rebekah Jo, "Implementation of a Screening Guideline for and Multidsciplinary Clinic Care of Pregnant Women with Underlying Cardiac Disease in an Urban Academic Healthcare System" (2021). ETD Collection for Thomas Jefferson University. AAI28870203.