Engaging Physicians to Improve Prenatal Screening for Heart Defects in Practice

Only 30-50% of congenital heart defects (CHD) are detected with prenatal screening. This falls far short of expected detection rates of 85% of CHD with obstetric ultrasound screening of low risk women in efficacy studies.In fact, although >90% of pregnant women currently have obstetric ultrasounds in the developed world, there has been no improvement in CHD detection rates over the past decade. There may be several reasons for this gap between research and practice. First, the majority of CHD cases occur in mothers with no identifiable risk factors. Therefore, prenatal detection of CHD primarily depends on population screening through the use of obstetric ultrasound rather than on targeted screening of individuals with risk factors by the fetal cardiologist. Second, the accuracy of the obstetrical screen depends on two individuals--the sonographer who obtains the images and the physician who interprets them. Finally, while most interventions to improve screening have been studied at academic or tertiary centers, the majority of women are screened in community settings. Thus, proposed interventions to improve detection rates have not been widely implemented in clinical practice. Determining the barriers to implementing best practice for CHD screening from the perspective of those practitioners who perform the majority of screening is crucial to improving detection rates. We propose extending our previous research using mixed methods to identify barriers to accurate screening from the perspective of obstetrical sonographers to identifying barriers from the perspective of the physicians who interpret obstetric screening ultrasounds.The specific aims of the proposed study are: 1. To determine the perceived barriers, knowledge, attitudes and behaviors regarding prenatal screening forCHD among physicianswho interpret prenatal ultrasounds. Primary outcome: Self-identified physician barriers to prenatal CHD screening and targets to improve screening success. Methods: Four focus groups will be conducted at PHN centers in different geographical regions of the United States to increase the generalizability of findings. Each focus group will consist of 6-8 physicians. Physicians will be recruited using multiple methods that were successful in recruiting sonographers practicing in a variety of settings for our pilot study. We will over-recruit by 10-15% for these groups using techniques recommended by Kreuger.[15]Physicians will be provided a $100 gift card for their time.Analysis of focus groups audio tapes will be undertaken using a five stage method.This will involve familiarization with the raw data, identification of categories and themes, as welldata indexing, charting, mapping, and interpretation using the framework of constant comparison. This data will be used to refine a future national survey of physicians who interpret ultrasounds.