Implementation of an Electronic Screening Tool to Detect Early GDM Uncovers Deficiencies

Intro: Given little consensus on screening/diagnosis for early GDM despite rapidly evolving expert opinion, providers are legitimately confused about who, how and when to screen. In 2017, the ADA modified their risk-based screening guidelines which were adopted by ACOG but implementation of these guidelines is largely unstudied. We compared rates of documented risk assessment before and after ACOG expanded screening criteria to determine rates of early testing and evaluate if an electronic screening form could increase documentation.

Methods: This QI study assessed provider screening practices before and after implementation of a new screening tool. Our academic center includes midwives, residents and OB/MFM faculty. In Oct 2017, in-person education and email surveys informed providers of a new electronic screening tool to promote GDM risk assessment. We reviewed initial visits at <20 weeks gestation. We examined rates of documentation, screening, risk factors and tests ordered.

Results: A random number sequence was used to identify 50 qualifying subjects by coding Nov 2016 and 2017 for a total of 100 patients. Prior to the screening tool 15/50 (30%) had documented risk assessment and 2/3 of these had testing ordered compared to 17/50 (34%) after the screening tool in which 1/2 were tested. A 1 hour, 50g test was ordered in 80% (2016) and in 88% (2017) and an A1c was ordered for the remaining. Of the 100 patients reviewed, 29 would have qualified for early testing based on race, ethnicity and BMI alone, but only 12 were tested.

Discussion: Unexpectedly, we found that early DM/GDM risk assessment is inadequately documented at our academic center and providing an electronic screening tool did little to increase documentation or adherence. Low rates of testing (<50% of high risk patients) are consistent with other data and suggest current strategies may be ineffective. Determining whether this reflects ambiguity over expert consensus or merely provider time constraints warrant active investigation.