ResearchObstetricsA system-based intervention to improve postpartum diabetes screening among women with gestational diabetes
Section snippets
KPNW GDM care
KPNW is a large, nonprofit, prepaid, federally certified, Joint Commission–accredited, group practice health maintenance organization with 470,000 members in western Oregon and Washington state. Most members receive prenatal care at 1 of 8 practice sites; 1 site serves as a maternal-fetal medicine referral practice. Screening for GDM is a component of usual care for pregnant women at KPNW. During the study period (June 2007 through December 2010), the standard of care was to screen all pregnant
Staff education
Approximately 72% (64/89) of clinicians, 90% (45/50) of registered nurses, and 66% (35/53) of medical assistants within the obstetrics department attended at least 1 education meeting. Mean satisfaction with the educational meetings was 4.82 (SD = 0.39) on a scale of 1 (poor) to 5 (outstanding).
Primary outcome data
From the 5250 live and stillbirths occurring within the preimplementation period and the 4765 in the postimplementation period, we identified 379 women with GDM (n = 200 pre, n = 179 post), yielding a
Comment
We hypothesized that education of staff and department-wide process changes would lead to both a significant increase in ordering of glucose tests for postpartum screening (provider behavior) and in increased glucose test completion (patient behavior). Our intervention resulted in a significant increase in glucose order placement. In fact, >90% of women delivering in the postimplementation period received a glucose test order. While the test completion rate appeared to be higher in the first 90
Acknowledgments
We would like to thank Donna Gleason for her assistance with chart abstraction, Nancy Perrin, PhD, for her assistance with statistical analyses, and Jerena Donovan and Joanne Rizzo for their assistance with data analyses. Ms Donovan, Ms Rizzo, Ms Gleason, and Dr Perrin were all employed by the Kaiser Permanente Center for Health Research at the time of their contributions. Ms Donovan's, Ms Rizzo's, and Ms Gleason's work on this project was funded by the Centers for Disease Control and
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(2011) ACOG practice bulletin no. 30: clinical management guidelines for obstetrician-gynecologists; September 2001 (replaces technical bulletin number 200, December 1994); gestational diabetes
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Cited by (0)
The obstetrics department of a large prepaid health maintenance organization was the setting of this study. Funded by contract number CDC 200-2009-31663, “Extent of Maternal Morbidity in a Managed Care Setting,” Centers for Disease Control and Prevention.
The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or Kaiser Permanente Northwest.
The authors report no conflict of interest.
Cite this article as: Vesco KK, Dietz PM, Bulkley J, et al. A system-based intervention to improve postpartum diabetes screening among women with gestational diabetes. Am J Obstet Gynecol 2012;207:283.e1-6.