January 25, 2019: A Learning Health System Story: Perinatal Outcomes Associated with a Major Change in Gestational Diabetes Screening (Sascha Dublin, MD, PhD, Gaia Pocobelli, PhD)

Speakers

Sascha Dublin, MD, PhD
Senior Investigator
Kaiser Permanente Washington Health Research Institute

Gaia Pocobelli, PhD
Research Associate
Kaiser Permanente Washington Health Research Institute

Topic

A Learning Health System Story: Perinatal Outcomes Associated with a Major Change in Gestational Diabetes Screening

Keywords

Health system; Gestational diabetes; Perinatal outcomes; Electronic health records; Learning health system

Key Points

  • In a learning health system, research influences practice, and practice influences research.
  • Gestational diabetes (GDM) is common, with a prevalence of 4% to 18% in pregnant women, depending upon population and testing strategy. This is why it’s important that the GDM screening process be demystified to determine which testing strategy approach is best.
  • While screening for and treating GDM to avoid adverse outcomes for women and babies is widely accepted, it is not clear which screening approach is best. Different organizations and professional societies have endorsed different approaches.
  • The presenters proposed a 1-step approach for GDM screening, including a 2-hour screening and lowered threshold to qualify for GDM. Electronic health records and linked state birth certificates served as the primary data sources in determining perinatal outcomes associated with changes to GDM screening.
  • Overall, there was no evidence of a benefit to the 1-step approach to GDM screening and diagnosis. Study findings were disseminated and led to practice change.

Discussion Themes

There is a plan to study de-implementation of the 1-step approach for GDM screening. This will help to show which changes had an impact. It will be interesting to compare the complexity of implementation versus de-implementation.

Also important will be the cost analysis of the study, which has not yet been completed.

Most healthcare systems have not adopted the 1-step strategy.

Tags

@kpwashington, @SaschaDublin, #healthsystem, #gestationaldiabetes, #perinatal, #electronichealthrecords, #pctGR