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Improving Maternal Care with a Continuous Quality Improvement Strategy: A Report from the Interventions to Minimize Preterm and Low Birth Weight Infants through Continuous Improvement Techniques (IMPLICIT) Network

Department of Family Medicine and Community Health and the Leonard Davis Institute of Health Economics, University of Pennsylvania School of Medicine, Philadelphia (IMB)
Department of Family and Community Medicine, Lancaster General Hospital, and the Lousie von Hess Medical Research Institute, Lancaster, PA (AC, MH, SR, ASG)
Forbes Family Medicine Residency Program, Monroeville, PA (JA)
Institute for Family Health Beth Israel Residency in Urban Family Practice, New York, NY (WBB)

Correspondence: Corresponding author: Ian M. Bennett, MD, PhD, Family Medicine and Community Health, 2nd Floor Gates Pavilion, 3400 Spruce Street, Philadelphia, PA 19104-4283 (E-mail: ian.bennett{at}uphs.upenn.edu)

Background: Maternal medical care (prenatal and postpartum) involves a set of clinical interventions addressing risk factors associated with important maternal and infant outcomes. Programs to increase the rate of delivery of these interventions in clinical practice have not been widely implemented.

Methods: A practice-based research network focused on developing continuous quality improvement (CQI) processes for maternal care among 10 family medicine residency training sites in the northeastern United States (the IMPLICIT Network) from January 2003 through September 2007. Documented delivery of 5 standard maternal care interventions was assessed before and after initiating a program to increase their frequency. Proportion chart analyses were conducted comparing the period before and after implementation of the CQI interventions.

Results: Data were available for 3936 pregnancies during the course of the study period. Results varied across the clinical interventions. Significant improvement in care processes was seen for 3 screening activities: (1) prenatal depression symptomatology (by 15 weeks’ gestation); (2) screening for smoking at 30 weeks’ gestation; (3) and postpartum contraception planning. Screening for smoking by 15 weeks’ gestation and testing for asymptomatic bacteriuria were already conducted >90% of the time during the baseline period and did not increase significantly after initiating the CQI program. Screening for postpartum depression symptomatology was recorded in 50% to 60% of women before the CQI program and did not increase significantly.

Conclusions: A practice-based research network of family medicine residency practices focused on CQI outcomes was successful in increasing the delivery of some maternal care interventions.

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