Development of a Clinical Risk Assessment Tool for 6-Week Postpartum Visit Nonadherence
17 July 2017
10 November 2017
13 December 2017 (eFirst)
Objective The 6-week postpartum visit (6WPP) is integral in addressing postpartum medical concerns. Failure to attend this routine visit is a measure of suboptimal care. This study aims to identify patients at risk of 6WPP nonadherence by developing a novel point-based risk scoring system.
Methods In this retrospective case–control study (n = 587), a randomly selected subgroup, that is, the “test” group (n = 303), was used to develop the model. The remaining patients were used as an independent “validation” group (n = 284) to assess the model performance.
Results Five factors were found to correlate with 6WPP nonadherence. Positive correlations include: Medicaid health insurance (odds ratio [OR]: 2.40, 95% confidence interval [CI]: 1.38–4.15); prenatal care initiated at ≥ 14 weeks' gestation (OR: 1.82, 95% CI: 1.11–2.96); and maternal age < 24.0 years (OR: 2.02, 95% CI: 1.13–3.61). Factors negatively correlated with nonadherence include: “married” marital status (OR: 0.50, 95% CI: 0.30–0.84) and primiparity (OR: 0.51, 95% CI: 0.30–0.85). The final scoring system demonstrates significant predictive power in both the test and validation groups (respectively, area under the curve = 0.682, p < 0.001 and 0.629, p < 0.001).
Conclusion This risk assessment tool relies on routinely collected data, making its implementation simple. Applying it in the clinical setting allows for early, targeted intervention aimed at minimizing 6WPP nonadherence.
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