Kaiser Permanente study highlights success of ultrasound screening program

Kaiser finds that referring only patients whose obstetric screening ultrasound shows fetal heart abnormalities for fetal echocardiograms maintains high prenatal detection rates and reduces unnecessary echocardiograms. A new study by Permanente reveals this.

“Many health systems recommend fetal echocardiography for pregnant patients based on a wide range of maternal and fetal risk factors, but there is no evidence that doing so improves detection rates or outcomes.” said lead author Dr. Sanjay Vepa, a pediatric cardiologist. Partnered with Permanente Medical Group. “This study provides evidence-based support that the model we introduced at Kaiser Permanente Northern California produces comparable results with fewer fetal echocardiograms.”

The retrospective study was published March 15 in the journal Prenatal Diagnosis. This is one of the largest studies to date evaluating this specific referral pathway for prenatal detection of significant congenital heart disease.

“This study highlights one of the referral pathways that our healthcare institution has developed that other healthcare institutions can benefit from,” said co-author of the study and an expert on health care delivery and policy. said Julie Schmiddiel, Ph.D., associate director and researcher at Keizer University. Permanente Northern California (KPNC) Research Division. “This is another exciting example of KPNC leading the way in improving the way care is delivered.”

Babies with severe congenital heart defects that are not detected before birth may not receive intervention as quickly as babies whose problems are discovered early. If these symptoms are not detected before birth, the risk of death increases. Within KPNC, all patients between 18 and 22 weeks of gestation undergo their initial obstetric ultrasound in the radiology or maternal-fetal medicine department. If an abnormality is noted during the initial screening, or if the parents or the baby have certain risk factors, a detailed obstetric ultrasound is done by the mother’s fetal medicine clinic.

This study highlights one referral pathway that our healthcare organization has developed that others may benefit from. This is another exciting example of how KPNC is leading the way in improving the way care is delivered.

—Dr. Julie Schmiddiel

If cardiac abnormalities are detected on obstetric ultrasound, the patient is referred to fetal cardiology for echocardiography. A pediatric cardiologist or a sonographer certified in fetal echocardiography will perform the echocardiogram at the KPNC Pediatrics or Fetal Cardiology Clinic. This test uses sound waves to create images of the heart so doctors can determine whether your baby’s heart is developing properly.

“Outside of KPNC, referrals for fetal echocardiograms are at least 10 times more common,” Vepa said. “This means there are many more patients being seen at other hospitals who may have increased anxiety about their baby. But our study shows that “We show that with a good screening program like ours, we can maintain high detection rates for serious congenital heart disease with fewer additional tests.”

The study also compared the detection rates of the two laboratory departments. The results showed that the prenatal detection rate was 75% in maternal fetal medicine and 52% in radiology. “This shows the impact of high-quality obstetric screening and confirms the progressive efforts within KPNC. All fetal ultrasound screenings are reviewed by our maternal-fetal medicine team,” said Vepa.

This study shows how KPNC initiates, researches, and improves care. “This study highlights Kaiser His Permanente’s strengths as a learning health system that carefully evaluates programs and initiatives and uses that information to inform care,” Permanente His Medical His Group said Douglas Corey, M.D., principal investigator.

The Centers for Medicare and Medicaid Services advocates for a nationwide transition to value-based care by 2030. Value-based care focuses on quality of care, provider performance, and patient experience. KPNC’s ultrasound screening program is an example of a value-based care program and may serve as a model for other health care providers.

“Our model for prenatal diagnosis of congenital heart disease represents Kaiser Permanente’s strength as a health system with a value-based care model,” Vepa said. “We are a leader in this field, and this approach was designed to provide integrated, patient-centered care.”

This study was funded by the Permante Medical Group Delivery Science and Applied Research Program.

Co-authors include Mubarika Alavi, MS, Weil Wu, MS, Lisa J. Herrington, PhD, and Kavin Desai, MD.

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About Kaiser Permanente Research Department

Kaiser Permanente’s Research Division conducts, publishes, and disseminates epidemiology and health services research to improve the health and health care of Kaiser Permanente members and society as a whole. We aim to understand the determinants of disease and health and improve the quality and cost-effectiveness of healthcare. Currently, his more than 600 staff members at DOR are working on his more than 450 epidemiology and health services research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow @KPDOR.