827: Effect of targeted prenatal education on acceptance of epidural analgesia: a randomized controlled trial

epidural analgesia: a randomized controlled trial Gregory Kanter, Matthew Garabedian, Brittany Rowe, Neena Duggal, Anita Sit Santa Clara Valley Medical Center, Obstetrics & Gynecology, San Jose, CA OBJECTIVE: Racial/ethnic disparities exist in the proportion of patients receiving epidural analgesia. We sought to determine if targeted prenatal educational program on womens’ perceptions of epidural increases the acceptance of intrapartum epidural analgesia. STUDY DESIGN: During prenatal care visits, patients were randomized to a video targeted at cultural myths and perceived risks of epidural presented in the subjects’ native language (English or Spanish) in addition to routine care versus routine prenatal care alone. They were asked to fill out a survey before and after their assigned intervention to assess desire and perception of epidurals. Desire for epidural and actual epidural rate at delivery were analyzed in the two groups. RESULTS: 111 women were randomized: 59 to the intervention group and 52 to the control group. The groups only differed on race/ethnicity, with the intervention group having more Hispanic women than the control group (65 v 43%, p 0.02). Rates of attending the routine prenatal epidural class were similar (40 v 40% p 0.97). The actual epidural rate was greater in the intervention group than the control group (81 v 67%; adjusted risk ratio [aRR] 1.4, 95% confidence interval [CI] 1.1-1.7). There were no significant differences in the stated desire to receive epidural rate in the educational intervention group compared to the control group (51 v 40%, p 0.19). After adjusting for race/ethnicity, the targeted educational video increased the likelihood of receiving a intrapartum epidural in all subjects regardless of stated desire for intrapartum epidural as indicated on the survey (Table). CONCLUSION: Participation in culturally-sensitive, targeted prenatal education increased epidural rate compared to routine prenatal care. This finding highlights the importance of patient-centered and culturally-sensitive educational efforts to improve informed decision making of intrapartum pain control to decrease the racial/ethnic disparity of epidural use in women. 828 Early hospital readmission after low risk cesarean delivery: evidence for racial and ethnic disparities Ilona Goldfarb, Erin Madden, Allison Bryant Harvard Medical School, Department of Maternal Fetal Medicine, Massachusetts General Hospital, Boston, MA, Northern California Institute for Research and Education, Department of Research, San Francisco, CA OBJECTIVE: Early hospital readmission rates following delivery are now recognized as a health care quality measure. We evaluated the impact of race/ethnicity on early postoperative readmission (within 14 days) in a population of patients undergoing a “low risk” cesarean delivery. STUDY DESIGN: We conducted a retrospective cohort study of all presumed “low risk” cesarean deliveries in California from 1999 to 2004. The cohort was defined as women with term gestations who had no antepartum hospital admissions, delivered a live born infant by cesarean on the same day as hospital admission (thus likely unlabored) and were discharged on or before the fourth post-operative day. Multivariate logistic regression was performed to control for maternal age, gestational age, parity, race/ethnicity, education, length of stay, rural county, as well as payer and hospital type. The results were also adjusted for maternal chronic conditions, antenatal disorders and immediate post-partum complications. RESULTS: Of 391,433 women delivered by a low risk cesarean, 3375 (0.9%) were readmitted within 2 weeks. Black women were 48% more likely to be readmitted compared to white women, while Hispanic and Asian women were less likely to be readmitted (see table). Other risk factors for readmission included extremes of age, nulliparity and maternal conditions such as hypertension and diabetes. Obstetrical conditions such as placenta previa or multiple gestations did not statistically increase the risk for early readmission, though the occurrence of a postpartum hemorrhage or uterine rupture did. The most common indications for readmissions in this cohort were infection (28%) and wound disorders (25%). CONCLUSION: Even among a lower risk population, black women are at significantly increased risk of early readmission after cesarean delivery. Strategies to minimize this disparity in a significant quality of care outcome may need to focus upon hospital discharge procedures and transitions of care for this and other high risk groups. A bar chart to show the proportion of women from areas with a ‘high’, ‘low’ or ‘neither high nor low’ IMD score who booked for antenatal care prior to 14 weeks gestation or later than 20 weeks of gestation Effect of educational video on actual epidural use