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Electronic Medical Record and Adherence to Guidelines for the Prevention of Group B Beta-hemolytic Streptococcus Disease in Neonates

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  • Medicine


Background: Group B beta-hemolytic streptococcal (GBS) disease causes significant neonatal morbidity and mortality in the United States. Universal screening and use of intrapartum prophylaxis for women identified to be at risk has been promoted through recent Centers for Disease Control (CDC) national guidelines. Despite the recommendation for universal screening, many women present in labor with unknown GBS status. Interventions that decrease rates of unknown GBS status may improve providers' ability to effectively implement the GBS prevention guideline. Research Question: r Does electronic access to GBS screening results reduce the rates of both unknown GBS status and subsequent delivery of inappropriate care for the prevention of GBS disease? Study Design: A retrospective cohort study using data from an extensive perinatal database is described. Included subjects are women delivering babies at University of North Carolina (UNC) Women's Hospital between 1996 and 2003, who received care at a university managed or affiliated prenatal care site. Rates of delivery of appropriate care based on GBS status are assessed and the effect of access to an electronic medical record on rates of inappropriate care is examined. Results: A total of 7102 births were eligible for assessment of adherence to GBS prevention guidelines. 28.3% of women had unknown GBS status and 24.8% of the entire sample received inappropriate care. Lack of an electronic medical record (EMR) was significantly associated with both a higher rates of both unknown GBS status (OR 1.54. 95%CI 1.34-1.71) and inappropriate care (OR 1.12, 95% CI 1.11-1.13). Conclusions: Results of prenatal GBS screening, required in order to correctly implement GBS preventive measures, are often missing on admission to the hospital for delivery. Access to an electronic medical record improves the ability of providers to maximize the protective effect of GBS prevention measures.

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