Improving Postpartum Attendance among Women with Gestational Diabetes Using the Medical Home Model of Care

Marti D. Soffer; Patricia Rekawek; Stephanie Pan; Jessica Overbey; Joanne Stone

doi:10.1055/s-0041-1727216

American Journal of Perinatology, Table of Contents

Am J Perinatol 2023; 40(03): 313-318
DOI: 10.1055/s-0041-1727216

Original Article

Improving Postpartum Attendance among Women with Gestational Diabetes Using the Medical Home Model of Care

Marti D. Soffer

¹Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts

,

Patricia Rekawek

²Department of Obstetrics and Gynecology, New York University Langone Health, New York University Winthrop Hospital, New York University Long Island School of Medicine, New York, New York

,

Stephanie Pan

³Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York

,

Jessica Overbey

³Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York

,

Joanne Stone

⁴Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York

› Author Affiliations

Abstract

Objective Poor attendance at the 6-week postpartum (PP) visit has been well reported. Attendance at this visit is crucial to identify women who have persistent diabetes mellitus (DM) following pregnancies affected by gestational DM (GDM). The medical home model has eliminated barriers to care in various other settings. This study sought to improve PP attendance among women with GDM by jointly scheduling PP visits and the 2-month well infant visits.

Study Design All patients with a diagnosis of GDM who received care at a New York City–based publicly insured hospital clinic and delivered between October 2017 and June 2019 were eligible. Data were obtained via chart review. The primary outcome was attendance at the PP visit compared with previously published historical controls. Secondary outcomes were rates of PP glucose screening and well infant attendance.

Results Of the 74 patients enrolled, 41.9% were Hispanic and 17.6% were Black, mean age was 31.6 years, and 58.1% delivered vaginally. Attendance at the 6-week PP visit was 68.9%, and attendance at the infant visit was 55.1%. PP glucose testing was ordered for 76.5% of attendees at the PP visit, and of those ordered, 43.6% of attendees completed testing. All patients had joint visits requested, though only 70.3% of visits were scheduled jointly. Among those who were jointly scheduled, 71.2% of women attended, 57.7% of infants attended, and 7.7% of pairs attended on the same day. The PP visit attendance rate was not significantly different than the prior attendance rate (p = 0.84).

Conclusion This study was unable to improve PP visit attendance among women with GDM by jointly scheduling the 6-week PP visit and the 2-month well-infant visit. Future research could be directed toward a shared space where both women and children can be seen to attempt to increase PP visit attendance and monitoring for women with GDM.

Key Points

Attendance at the PP visit is poor, and without a visit, women with pregnancies affected by gestational diabetes remain unscreened for PP dysglycemia.
Jointly scheduling women and their infants to eliminate barriers to care studied by this group, however, were unable to improve attendance.
Innovative strategies are needed to improve PP attendance among women with pregnancies affected by GDM.

Keywords

gestational diabetes - medical home - postpartum - postpartum attendance

Full Text

References

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