An Electronic Medical Record Intervention to Increase Early Screening Rates for Gestational Diabetes

Shobha Jagannatham, Melissa Lozano, Lois Brustman

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Our objective was to implement an electronic medical record reminder to perform the early gestational diabetes screening test and to evaluate if this intervention increased screening rates. Study Design: We performed a retrospective chart review of all deliveries at Mount Sinai West in January 2020 to determine the number of patients that met criteria for and actually underwent early GDM screening. A total of 314 patients had complete charts with pregnancy data. The following ACOG-defined risk factors were collected: body mass index greater than 25 (Asians greater than 23), history of GDM, history of macrosomia, hypertension (systolic >140 or diastolic >90), polycystic ovarian syndrome, Hb A1C above 5.7, cardiovascular disease, and family history of diabetes. We used this data to advocate for and design an electronic medical record-based intervention to remind obstetric providers to complete the early GCT screening for eligible patients at the first prenatal visit. Results: Our investigation confirms there is a low adherence rate of 12% at our facility to ACOG's updated early GDM screening guidelines (12 out of 97 patients). Furthermore, nearly one-fifth (16 out of 85) of eligible patients who did not receive screening were eventually diagnosed with GDM by screening at 24-28 weeks. After implementing an electronic medical record reminder at the initial prenatal visit, screening rates more than doubled to 28% (33 out of 115 eligible patients). The most common diabetic risk factors were high-risk ethnic background, current hypertension, family history of diabetes, history of polycystic ovarian syndrome, and BMI of 40 or greater. Conclusion: Our data suggests that obstetricians could be missing an opportunity to improve maternal and neonatal outcomes by diagnosing GDM earlier in pregnancy, as recommended by ACOG. The adoption of an electronic medical record reminder seems to improve the rate of indicated early GDM screening.

Original languageEnglish
JournalAmerican Journal of Perinatology
DOIs
StateAccepted/In press - 2022
Externally publishedYes

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