Universal Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) Testing Uptake in the Labor and Delivery Unit: Implications for Health Equity.
Adult
Betacoronavirus
COVID-19
COVID-19 Testing
Clinical Laboratory Techniques
Coronavirus Infections
/ diagnosis
Cross-Sectional Studies
Female
Health Equity
Hospitalization
Humans
Labor, Obstetric
Logistic Models
Missouri
Pandemics
Patient Acceptance of Health Care
/ psychology
Pneumonia, Viral
/ diagnosis
Pregnancy
Pregnancy Complications, Infectious
/ diagnosis
SARS-CoV-2
Young Adult
Journal
Obstetrics and gynecology
ISSN: 1873-233X
Titre abrégé: Obstet Gynecol
Pays: United States
ID NLM: 0401101
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
pubmed:
29
8
2020
medline:
2
12
2020
entrez:
29
8
2020
Statut:
ppublish
Résumé
To understand severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing uptake in the labor and delivery unit and rationales for declining testing, and to institute a process to increase equitable testing uptake. We conducted a quality-improvement initiative from May 28-June 25, 2020, during the first 4 weeks of universal SARS-CoV-2 testing in the Barnes-Jewish Hospital labor and delivery unit. All consecutive patients presenting for delivery without coronavirus disease 2019 (COVID-19) symptoms were offered testing over four 1-week phases. Phase I documented the rate of testing uptake. Phase II recorded patients' reasons for declining testing. Phase III used phase II findings to create and implement shared decision-making tools. Phase IV offered each patient who declined nasopharyngeal testing an oropharyngeal alternative. The primary outcome was rate of SARS-CoV-2 testing uptake by phase. Of 270 patients, 223 (83%) accepted testing and 47 (17%) declined. Maternal age and mode of delivery were similar between groups, whereas testing uptake was higher among nulliparous, White, Hispanic, or privately insured patients. There was a significant increase in the primary outcome of SARS-CoV-2 testing across phases I-IV, from 68% to 76% to 94% to 95%, respectively (Somers' D 0.45; 95% CI of association 0.30-0.59). The most commonly cited reason for declining testing was concern regarding testing discomfort. In subgroup analyses by race and insurance type, there was a significant increase in testing uptake across phases I-IV for Black patients (56%, 54%, 91%, 92%; Somers' D 0.36; 95% CI of association 0.28-0.64), White patients (76%, 93%, 96%, 100%; Somers' D 0.59; 95% CI of association 0.38-0.8), those with Medicaid insurance (60%, 64%, 88%, 92%; 95%; Somers' D 0.39; CI of association 0.22 to 0.56), and those with private insurance (77%, 96%, 97%, 100%; Somers' D 0.63; 95% CI of association 0.40-0.86). Universal SARS-CoV-2 testing uptake significantly increased through a rapid-cycle improvement initiative. Aligning hospital policy with patient-centered approaches led to nearly universally acceptable testing.
Identifiants
pubmed: 32858567
doi: 10.1097/AOG.0000000000004127
pii: 00006250-202012000-00007
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1103-1108Références
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