Prenatal care routine questionnaire star

Adapting the Questionnaire Star tool to routine prenatal care assessment scenarios can increase the efficiency of outpatient prenatal care assessment by an average of 32% and reduce the omission rate of routine medical history by 27%. It also supports needs such as personalized skipping of questions and automatic statistics of high-risk factors. However, there are still two major industry controversies: poor adaptation for elderly/low digital level pregnant women and concerns about data privacy, and a unified promotion standard has not yet been formed.

When I was rotating in the obstetrics clinic of a tertiary maternal and child health hospital last year, I happened to catch up with the department to launch this tool. The comparison before and after was really obvious. In the past, the clinic had to receive more than 80 pregnant women for prenatal check-ups in the morning during the peak period. The routine nursing assessment of each pregnant woman took 15 minutes: gestational age, weight gain, fetal movement, diet and rest, whether there is edema and dizziness, past medical history... The nurse held a stack of typing in her hand. The printed evaluation form makes me thirsty when asked, and it is inevitable to miss items when there are many people. After get off work, I have to enter the data from dozens of forms into the system one by one. Just counting the high-risk groups of gestational hypertension and diabetes every week requires two nurses to work overtime for half a night.

There was also a joke when we first changed the questionnaire. My colleagues in the Information Department did not understand the clinical requirements of obstetrics and set the options for fetal movement counting to "good/average/poor". We almost died of anger. How could there be such a rough classification? Later, it was changed back to "≥30 times in 12 hours/20-29 times in 12 hours/<20 times in 12 hours/not counted", and the logic of five-color management of high-risk pregnancy was embedded: as long as the pregnant woman fills in high-risk items such as a history of heart disease, multiple miscarriages, and blood pressure higher than 140/90mmHg, after submission, the backend will automatically mark the corresponding risk level in red, and the nurse will be able to see the key points as soon as she opens it. Don't tell me, after the change, a lot of things have been saved. Pregnant women can fill it out at home or while waiting in line. When they arrive at the clinic, the nurse no longer has to ask for basic information from the beginning, but can just focus on the abnormal items. The time saved can be used to talk to high-risk pregnant women about precautions. Last month, the satisfaction of pregnant women in our outpatient clinic increased by 8 points. Many people said that they don't have to stand there and be questioned for a long time, and can just sit and fill in the mobile phone.

To be honest, I initially thought that this kind of general questionnaire tool would not be rigorous enough when dealing with medical-related content. After I actually used it, I discovered that as long as the logic is set up correctly and privacy is taken care of, it is much more reliable than the human brain. After all, nurses will inevitably get distracted when asking dozens of people a day, and the system’s question-hopping logic will not be missed. But there is indeed a lot of controversy about this matter in the industry. Our department was divided into two groups at that time: the young nurses supported it with both hands, saying that they no longer have to stay up late to record data. When a 29-week-pregnant mother filled out the questionnaire by herself, she noted that "in the past week, she was breathless while walking and her feet were so swollen that she couldn't wear shoes." When we saw it, we directly measured her blood pressure and urine protein, and found out early preeclampsia in time. If we had followed the original process, we might have missed this detail when there were so many people. ； Most of the nurses with senior qualifications are a little hesitant. On the one hand, there are many pregnant women from the county and mothers of second children over 35 who are not very good at using smartphones. They can't fill it out for a long time on their mobile phones, which is a waste of time. On the other hand, there are privacy concerns. A pregnant mother said that she had filled out pregnancy questionnaires from other institutions. The next day, she received a sales call from the Trimester Center and refused to fill in the online form.

Looking at the entire industry, the differences are even more obvious: Practicalists believe that most grassroots hospitals do not have the funds to develop their own dedicated prenatal assessment systems. Questionnaire Star is almost zero cost. As long as it complies with the "Data Security Management Standards for Medical Institutions", signs a confidentiality agreement, stores the data in the hospital's exclusive cloud server, and turns off all third-party advertising jumps, it is completely usable. On the contrary, it can help grassroots hospitals quickly conduct follow-up management of high-risk pregnant women.； Conservatives insist that as long as third-party tools are used, there is a risk of data leakage. Prenatal assessment involves pregnant women’s medical history, address, ID number and other sensitive information, and must use an internal module that is fully integrated with the hospital’s HIS system to be compliant.

We are now taking a middle-of-the-road compromise and will not force everyone to fill in the online questionnaire: we will use the star link of the smartphone to send the questionnaire three days in advance, and it will be automatically archived in the background. Those who do not know how to use it will still take the paper form when they go to the hospital. The nurse will help fill it out and then manually enter it into the system. The data from both sides will be imported together for statistics, which is not a lot of trouble. The template has been revised almost ten times in the past six months. At first, non-essential items such as occupation and family income were placed at the front, and the effective questionnaire rate was only 62%. Later, they were all moved to the end and set as optional, and the effective rate directly increased to 91%. Last time the country released a new pregnancy health care guide, it took us half an hour to add the new assessment items, which was much more cost-effective than reprinting the paper form.

Anyway, there is no need to boast that it is a god-level tool, and there is no need to beat it to death by saying that online questionnaires are unsafe. After all, the core of prenatal care is never what tool to use, but whether it can catch the risk points of pregnant women in time and help them give birth to their children smoothly. As long as it can achieve this purpose and use it smoothly, it will be fine.