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Evaluation of the impact of fetal fibronectin test implementation on hospital admissions for preterm labour in O ntario: a multiple baseline time‐series design
Author(s) -
Fell DB,
Sprague AE,
Grimshaw JM,
Yasseen AS,
Coyle D,
Dunn SI,
Perkins SL,
Peterson WE,
Johnson M,
Bunting PS,
Walker MC
Publication year - 2014
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12511
Subject(s) - medicine , confidence interval , confounding , population , psychological intervention , interrupted time series , pediatrics , emergency medicine , environmental health , psychiatry
Objective To determine the impact of a health system‐wide fetal fibronectin (f FN ) testing programme on the rates of hospital admission for preterm labour ( PTL ). Design Multiple baseline time‐series design. Setting Canadian province of O ntario. Population A retrospective population‐based cohort of antepartum and delivered obstetrical admissions in all O ntario hospitals between 1 A pril 2002 and 31 M arch 2010. Methods International Classification of Diseases codes in a health system‐wide hospital administrative database were used to identify the study population and define the outcome measure. An aggregate time series of monthly rates of hospital admissions for PTL was analysed using segmented regression models after aligning the f FN test implementation date for each institution. Main outcome measure Rate of obstetrical hospital admission for PTL . Results Estimated rates of hospital admission for PTL following f FN implementation were lower than predicted had pre‐implementation trends prevailed. The reduction in the rate was modest, but statistically significant, when estimated at 12 months following f FN implementation (−0.96 hospital admissions for PTL per 100 preterm births; 95% confidence interval [CI], −1.02 to −0.90, P = 0.04). The statistically significant reduction was sustained at 24 and 36 months following implementation. Conclusions Using a robust quasi‐experimental study design to overcome confounding as a result of underlying secular trends or concurrent interventions, we found evidence of a small but statistically significant reduction in the health system‐level rate of hospital admissions for PTL following implementation of f FN testing in a large C anadian province.