Research
Obstetrics
A system-based intervention to improve postpartum diabetes screening among women with gestational diabetes

Presented orally at the annual HMO Research Network meeting, Seattle, WA, April 29-May 2, 2012, and in poster format at the Diabetes in Pregnancy Study Group–West annual meeting, Pasadena, CA, May 18-19, 2012.
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Objective

We sought to determine whether our process improvement program led to increased postpartum diabetes screening rates among women with gestational diabetes mellitus (GDM).

Study Design

In early 2009, we conducted obstetrics department staff education sessions, revised GDM patient care protocols, and developed an electronic system to trigger reminder calls to patients who had not completed diabetes mellitus screening by 3 months postpartum. We then evaluated the rates of postpartum glucose test order entry and completion for women with GDM delivering from July 2009 through June 2010 (n = 179) and July 2007 through June 2008 (n = 200).

Results

After the program's implementation, the proportion of women receiving an order for a postpartum glucose test within 3 months of delivery increased from 77.5-88.8% (P = .004), and test completion increased from 59.5-71.5% (hazard ratio, 1.37; 95% confidence interval, 1.07–1.75).

Conclusion

Rates of postpartum diabetes testing can be improved with system changes and reminders.

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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There are more references available in the full text version of this article.

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.

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