CoChat
Sign Up
Cited by 128Clinical practice guidelines implementationNeonatal Respiratory Health ResearchHealth Policy Implementation Science

Methods to Encourage the Use of Antenatal Corticosteroid Therapy for Fetal Maturation: A Randomized Controlled Trial

Leviton, Laura C., Goldenberg, Robert L., Baker, C. Suzanne, Schwartz, Rachel M., Freda, Margaret C., Fish, Larry J., Cliver, Suzanne P., Rouse, Dwight J. +3 more·1999·JAMA
DOI 10.1001/jama.281.1.46
Open this paper in CoChat — free account

Abstract

CONTEXT: Antenatal corticosteroids for fetal maturation have been underused, despite evidence for their benefits in cases of preterm birth. OBJECTIVE: To evaluate dissemination strategies aimed at increasing appropriate use of this therapy. DESIGN AND SETTING: Twenty-seven tertiary care institutions were randomly assigned to either usual dissemination of practice recommendations (n = 14) or usual dissemination plus an active, focused dissemination effort (n = 13). SUBJECTS: Obstetricians and their preterm delivery cases at participating hospitals. INTERVENTION: Recommendations by a National Institutes of Health (NIH) Consensus Conference held in late February-early March 1994 were disseminated in early May 1994. Usual dissemination was publication of the recommendations and endorsement by the American College of Obstetricians and Gynecologists. Active dissemination was a year-long educational effort led by an influential physician and a nurse coordinator at each facility, consisting of grand rounds, a chart reminder system, group discussion of case scenarios, monitoring, and feedback. MAIN OUTCOME MEASURE: Use or nonuse of antenatal corticosteroids was abstracted from medical records of eligible women delivering at the participating hospitals in the 12 months immediately prior to release of the NIH recommendations (average number of records abstracted, 130) and in the 12 months following their release (average number of records abstracted, 122). RESULTS: Active dissemination significantly increased the odds of corticosteroid use after the conference. Use increased from 33.0% of eligible patients receiving corticosteroids to 57.6%, or by 75% over baseline, in usual dissemination hospitals. Use increased from 32.9% to 68.3%, oran 108% increase, in active dissemination hospitals. Gestational age and maternal diagnosis affected use of the therapy in complex ways. CONCLUSION: An active, focused dissemination effort increased the effectiveness of usual dissemination methods when combined with key principles to change physician practices.

Integrity signals

Registry

Crossref · 10.1001/jama.281.1.46

Cites

20 of 20 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Leviton, L. C., Goldenberg, R. L., Baker, C. S., Schwartz, R. M., Freda, M. C., Fish, L. J., Cliver, S. P., Rouse, D. J., Chazotte, C., Merkatz, I. R., & Raczynski, J. M.
Affiliations
  • Brown University (US)
  • University of Alabama at Birmingham (US)
  • Yeshiva University (US)
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
1999-01-06
Volume
281
Issue
1
Pages
46
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.281.1.46
OpenAlex
W2108660596
Cited by
128
References
20
Citations by year
2026: 1 · 2025: 2 · 2024: 1 · 2023: 1 · 2022: 2 · 2021: 4 · 2020: 4 · 2019: 3 · 2018: 3 · 2017: 6 · 2016: 5 · 2015: 5 · 2013: 3 · 2012: 6
FWCI
6.65
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Funders
U.S. Public Health Service (290-92-0055)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Keywords
antenatal corticosteroids, fetal lung maturation, preterm birth, NIH consensus conference, physician practice change, clinician feedback, obstetricians, guideline implementation
MeSH terms
Anti-Inflammatory Agents, Betamethasone, Dexamethasone, Drug Utilization, Female, Embryonic and Fetal Development, Gestational Age, Glucocorticoids, Humans, Infant, Newborn, Infant, Premature, Infant, Premature, Diseases, Obstetric Labor Complications, Obstetric Labor, Premature, Pregnancy, United States, Consensus Development Conferences, NIH as Topic, Practice Guidelines as Topic, Pregnancy, High-Risk, Guideline Adherence

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review