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Do Maternal Characteristics Affect Nuchal Translucency Variation? Nuchal Translucency Quality Review program: 5 million results
L Dugoff MD, H Cuckle MD, LD Platt MD, K Fuchs MD, J McIntosh MD, J Spitz MPH, RDMS, B Bromley MD, LL Thornburg MD
on behalf of Perinatal Quality Foundation
OBJECTIVE
To evaluate the relationship between NT median MoM and maternal characteristics from NT data
collected 1/2005-3/2019
Maternal characteristics
including age, weight, race/ethnicity
and fetal number significantly affect
NT median MoMs.
RESULTS:
Total of 5,234,950 NT imaging scans performed by 9340 providers at 3319 sites.
In multiple regression analysis variables remained statistically significant except IVF (P=0.28).
For subset of 2,547,258 results with complete information MoMs were recalculated dividing the observed NT MoM by the expected NT MoM, from the regression equation, with the overall median reduced by 2%.
CONCLUSIONS:
Maternal characteristics including maternal age, weight, race/ethnicity and fetal number significantly affect NT median MoMs.
It is critical that providers submit complete data for these variables to laboratories with the NT to optimize the calculation of Down syndrome risk.
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Obesity and Nuchal
Translucency Measurement:
Do we under call abnormal?
E Westen MD, A Hesson MD, GT Toland MS, B Bromley MD, LD Platt MD, LL Thornburg MD, J McIntosh MD
OBJECTIVE
To assess for evidence of systematic over or
undermeasurement approximated by flattening of NT-
CRL curve with increasing maternal weight
METHODS:
All singleton NT scans submitted 2012-18
Maternal weights >170 lbs in quartiles
NT plotted against CRL
Multiple linear regression model
RESULTS
29,321 scans with maternal weight >170 lbs
Slopes ranged from 3.1-3.7 across the four NT-CRL curves by weight quartile
A multiple regression model selected CRL as a significant predictor of NT (p<0.1), but not weight (p=0.32) or their interaction (p=0.61)
NT curves are maintained
across CRL in the setting of
maternal obesity
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Maintaining Optimal Performance: Characteristics of providers requiring remediation within the NTQR review program
PS Marinescu, MD; LD Platt, MD; K Fuchs, MD,MHA; B Bromley, MD; L Dugoff, MD; ME Norton, MD; GJ Toland, MS; LL Thornburg, MD
on behalf of the Perinatal Quality Foundation
Background
Nuchal Translucency Quality Review Program (NTQR) provides credentialing and ongoing quality monitoring of NT measurements
When measurements are out of range (OOR) on > 2 consecutive quarterly reports, providers are assigned to re-mediation (required quality maintenance-RQM)
We sought to describe provider characteristics predictive of need for RQM and repeated RQM within NTQR
METHODS:
Case control study: A random sample of 70 OORP vs 70 in- range providers (IRP) was compared for characteristics associated with RQM
We assessed rate of RQM over 20 reporting periods (5/2011-7/2017)
Statistical analysis was performed using chi-square, t-test, and Fisher’s exact test, as appropriate
Practice monitoring and remediation is associated with significant improvement in NT performance
Quality maintenance is necessary to maintain high-reliability systems within healthcare
Among out of range providers, physicians had:
Lower rates of repeat RQM (18% vs 49%, p <.003)
Fewer batches required to complete RQM (10% vs 14%, p <.03)
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Does Maternal Age Impact Nuchal Translucency Utilization since the Introduction of Cell-Free DNA
LL Thornburg MD, LD Platt, MD, GT Toland MD, L Dugoff MD, J Mcintosh MD, K Fuchs MD, M Norton MD, B Bromley, MD
on behalf of Perinatal Quality Foundation
OBJECTIVE
To assess changes in NT volume for patients > 35 years old with both singleton & twin pregnancies since introduction of cfDNA screening
METHODS:
Review of total NTQR volumes 2012-18 for singleton and twin pregnancies, stratified by age <35 vs. >35 y/o at delivery
There has been a significant reduction NT screening performed annually for both singleton & twin patients > 35 years old since the introduction of cell free DNA screening
Changes in NT scan volume twins and singletons by Maternal Age
singletons & twins <35
Little variation in the annual NT volume 2012 to 2017
Significant drop after 2016 for singletons; 2017 for twins, p<.01
For singletons & twins >35
Singletons dropped significantly every year after 2016 (p<.01)
Twins dropped significantly every year after 2012 (p<.0001)
Since 2012, annual NT volume for AMA singletons has decreased by 48.9% while twins has decreased by 50%
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Trends in volume of nuchal translucency scans and credentialed providers since introduction of cell-free DNA
B Bromley MD, LL Thornburg MD, L Dugoff MD, KM Fuchs MD, LD Platt MD, GJ Toland MS, ME Norton MD
on behalf of Perinatal Quality Foundation
OBJECTIVE
To assess changes in volume of NT scans and providers reporting NT data since introduction of cf-DNA
METHODS:
Determined total volume of NT scans submitted to NTQR annually from 1/2012 thru 12/2018.
Evaluated average number of NT scans per month and variation between years (ANOVA and post-hoc paired t-tests.)
Compared number of providers active in the program, and number submitting paired NT/CRL data in the 4th quarter of each year.
RESULTS:
Total 3,638,899 NT scans reported
Average 519,843 (+40351) per year
Annual NT volume decreased while number of providers increased (Table, Figure)
Little variation in the annual NT volume between 2012 to 2015
Significant volume decrease between 2015 and 2018 (p<.0001).
Since 2012, annual NT volume has decreased by 20%, while the number of providers active in NTQR has increased 21.9% and those submitting 4th quarter data increased by 26.2%.
Annual number of NT scans has decreased by 20% since the introduction of cell-free DNA
Number of providers active in NTQR and submitting data has increased by 22% and 26% respectively
DISCUSSION:
National trends in screening for aneuploidy demonstrate a decreased utilization of combined screening programs since clinical availability of cf-DNA
Providers continue to utilize combined screening for aneuploidy in clinical practice.
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Do Provider Characteristics Affect Nuchal Translucency Variation? NTQR Program: 5 Million Results
LL Thornburg, MD; B Bromley, MD; LD Platt, MD; L Dugoff MD; J Mcintosh MD, J Spitz, MPH, RDMS; H Cuckle MD
on behalf of Perinatal Quality Foundation
OBJECTIVE
We reviewed NT data 1/2005-3/2019 to assess the effect of provider characteristics on the median NT measurement
METHODS:
Relationship between NT median MoM and provider characteristics evaluated using Wilcoxon Rank Sum Test, ANOVA, multiple regression)
Provider characteristics explored as potential sources of variability among NT median MoM including:
NTs performed annually (volume)
duration of participation in NTQR
prior credentialing by other NT organization
provider type (physician/sonographer)
number NT credentialed providers in practice (size)
Provider characteristics including length of experience, high volume & having credentialed colleagues are all significantly associated with higher NT median MoMs
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