Abstract
Objectives To improve clinical practice and increase postpartum visit Type 2 diabetes mellitus (T2DM) screening rates in women with a history of gestational diabetes mellitus (GDM). Methods We recruited clinical sites with at least half of pregnant patients enrolled in Medicaid to participate in an 18-month quality improvement (QI) project. To support clinical practice changes, we developed provider and patient toolkits with educational and clinical practice resources. Clinical subject-matter experts facilitated a learning network to train sites and promote discussion and learning among sites. Sites submitted data from patient chart reviews monthly for key measures that we used to provide rapid-cycle feedback. Providers were surveyed at completion regarding toolkit usefulness and satisfaction. Results Of fifteen practices recruited, twelve remained actively engaged. We disseminated more than 70 provider and 2345 patient toolkits. Documented delivery of patient education improved for timely GDM prenatal screening, reduction of future T2DM risk, smoking cessation, and family planning. Sites reported toolkits were useful and easy to use. Of women for whom postpartum data were available, 67 % had a documented postpartum visit and 33 % had a postpartum T2DM screen. Lack of information sharing between prenatal and postpartum care providers was are barriers to provision and documentation of care. Conclusions for Practice QI and toolkit resources may improve the quality of prenatal education. However, postpartum care did not reach optimal levels. Future work should focus on strategies to support coordination of care between obstetrical and primary care providers.
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References
American College of Obstetricians and Gynecologists. (2013). Practice bulletin number 137: Gestational diabetes mellitus. Obstetrics and Gynecology, 122(Supplement 2 Part 1), 406–416.
American Diabetes Association. (2013). Standards of medical care in diabetes—2013. Diabetes Care, 36 (Supplement 1), S11–S66.
Bardenheier, B. H., Imperatore, G., Gilboa, S. M., Geiss, L. S., Saydah, S. H., Delvin, H. M., … Gregg, E. W. (2015). Trends in gestational diabetes among hospital deliveries in 19 U.S. states, 2000–2010. American Journal of Preventive Medicine, 49(1), 12–19.
Bellamy, L., Casas, J. P., Hingorani, A. D., & Williams, D. (2009). Type 2 diabetes mellitus after gestational diabetes: A systematic review and meta-analysis. Lancet, 373, 1773–1779.
Care Coordination. (content last updated July 2016). At Agency for Healthcare Research and Quality, Rockville, MD online. Retrieved from http://www.ahrq.gov/professionals/prevention-chronic-care/improve/coordination/index.html.
Centers for Disease Control and Prevention. (2014). National diabetes statistics report: Estimates of diabetes and its burden in the United States, 2014. Accessed November 10, 2015, from http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf.
Cheung, N. W., & Byth, K. (2003). Population health significance of gestational diabetes. Diabetes Care, 26(7), 2005–2009.
DeSisto, C. L., Kim, S. Y., & Sharma, A. J. (2015). Prevalence estimates of gestational diabetes mellitus in the United States, pregnancy risk assessment monitoring system (PRAMS), 2007–2010. Preventing Chronic Disease, 11, 130415. doi:10.5888/pcd11.130415.
Feig, D. S., Zinman, B., Wang, X., & Hux, J. E. (2008). Risk of development of diabetes mellitus after diagnosis of gestational diabetes. Canadian Medical Association, 179(3), 229–234.
Ferrara, A., Hedderson, M. M., Ching, J., Kim, C., Peng, T., & Crites, Y. M. (2012). Referral to telephonic nurse management improves outcomes in women with gestational diabetes. American Journal of Obstetrics and Gynecology, 206(6), 491–495.
Gunderson, E. P., Hurston, S. R., Ning, X., Lo, J. C., Crites, Y., Walton, D., … Quesenberry, C. P. (2015). Lactation and progression to type 2 diabetes mellitus after gestational diabetes mellitus: A prospective cohort study. Annals of Internal Medicine, 163(12), 889–898.
Hale, N., Picklesheimer, A. H., Billings, D. L., & Covington-Kolb, S. (2014). Impact of centering pregnancy group prenatal care on postpartum family planning. American Journal of Obstetrics and Gynecology, 210(1), 1–7. doi:10.1016/j.ajog.2013.09.001.
Hildebrand, D. A., McCarthy, P., Tipton, D., Merriman, C., Schrank, M., & Newport, M. (2014). Innovative use of influential prenatal counseling may improve breastfeeding initiation rates among WIC participants. Journal of Nutrition Education and Behavior, 46(6), 458–466.
Hunt, K. L., & Conway, D. L. (2008). Who returns for postpartum glucose screening follow gestational diabetes mellitus? American Journal of Obstetrics and Gynecology, 198, 404.e1–404.e6.
Ko, J. Y., Dietz, P. M., Conrey, E. J., Rodgers, L., Shellhaas, C., Farr, S. L., & Robbins, C. L. (2013a). Gestational diabetes mellitus and postpartum care practices of nurse-midwives. Journal of Midwifery and Women’s Health, 8(1), 33–40.
Ko, J. Y., Dietz, P. M., Conrey, E. J., Rodgers, L., Shellhaas, C., Farr, S. L., & Robbins, C. L. (2013b). Strategies associated with higher postpartum glucose tolerance screening rates for gestational diabetes mellitus patients. Journal of Women’s Health, 22(8), 681–686.
Langley, G. L., Moen, R., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd Ed.). San Francisco, CA: Jossey-Bass Publishers.
Oza-Frank, R., Bouchard, J., Conrey, E., Shellhaas, C., & Weber, M.B. (2015). Health care experiences of low-income women with gestational diabetes and suggestions for improving care [abstract]. Diabetes, 64(Supplement 1), A672.
Oza-Frank, R., Ko, J. Y., Wapner, A., Rodgers, L., Bouchard, J., & Conrey, E. J. (2014). Improving care for women with a history of gestational diabetes: A provider perspective. Maternal and Child Health Journal, 18(7), 1683–1690.
Oza-Frank, R., Shellhaas, C., Wapner, A., & Conrey, E. (2011). Gestational diabetes in Ohio: 2006–2008. Ohio Department of Health. Accessed November 10, 2015, from https://www.odh.ohio.gov/~/media/ODH/ASSETS/Files/prams%20-%20pregnancy%20risk%20assessment%20monitoring%20program/Reports%20and%20Fact%20Sheets/ohiogdm_databook_oct_2011.pdf.
Ratner, R. E., Christophi, C. A., Metzger, B. E., Dabelea, D., Bennett, P. H., Pi-Sunyer, X., … The Diabetes Prevention Program Research Group. (2008). Prevention of diabetes in women with a history of gestational diabetes: Effects of metformin and lifestyle interventions. Journal of Clinical Endocrinology and Metabolism, 93(12), 4774–4779.
Rayburn W. F., Petterson, S. M., & Bazemore, A. (2014). Preferences of sites for office-based care by reproductive-aged women. Obstetrics & Gynecology, 123, 88S. doi:10.1097/01.AOG.0000447420.16812.c8.
Rodgers, L., Conrey, E. J., Wapner, A., Ko, J. Y., Dietz, P., & Oza-Frank, R. (2014). Primary healthcare providers’ knowledge and attitudes regarding care for women with histories of gestational diabetes. Preventing Chronic Disease, 11, 1403–1408.
Stormo, A. R., Saraiya, M., Hing, E., Henderson, J. T., & Sawaya, G. F. (2014). Women’s clinical preventive services in the United States: Who is doing what? Journal of the American Medical Association Internal Medicine, 174(9), 1512–1514.
Vesco, K. K., Dietz, P. M., Bulkley, J., Bruce, F. C., Callaghan, W. M., England, L., … Hornbrook, M. C. (2012). A system-based intervention to improve postpartum diabetes screening among women with gestational diabetes. American Journal of Obstetrics and Gynecology, 207(4), 281–286.
Weber, M. B., Bouchard, J., Conrey, E., Shellhaas, C., & Oza-Frank, R. (2015). Type 2 diabetes screening, risk and prevention among low-income women with a history of gestational diabetes [abstract]. Diabetes, 64(Supplement 1), A674.
Yarrington, C., & Zera, C. (2015). Health systems approaches to diabetes screening and prevention in women with a history of gestation diabetes. Current Diabetes Report, 15, 114–119.
Acknowledgments
Clinical subject matter experts: Steven Gabbe MD; Mark Landon, MD; Stephen Thung, MD—The Ohio State University College of Medicine, Division of Maternal Fetal Medicine. Toolkit development: Health Services Advisory Group—Phoenix, Arizona. Pilot sites: Akron Children’s Hospital Maternal Fetal Medicine—Akron, Ohio; Center for Health Services at Promedica—Toledo, Ohio; Cleveland Clinic Foundation, Cleveland, Ohio; Diabetes Wellness Center of Atrium Medical Center—Middletown, Ohio; Madison County Hospital—London, Ohio; Mercer Health Disease Management Clinic—Coldwater, Ohio; Mercy Health Anderson OB/GYN Care Center—Cincinnati, Ohio; OB/GYN Specialists of Lima—Lima, Ohio; Ohio Health O’Bleness Hospital, Athens Medical Associates—Athens, Ohio; Ohio State University Maternal Fetal Medicine—Columbus, Ohio; Ohio State University OB/GYN Clinics—Columbus, Ohio; Pickaway Health Center of Berger Health Systems—Circleville, Ohio; Summa Health System—Akron, Ohio; University of Cincinnati Medical Center—Cincinnati, Ohio; University Hospitals MacDonald Women’s Hospital—Cleveland, Ohio.
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The Ohio Office of Health Transformation.
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Jo Bouchard—Retired from The Ohio Department of Health
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Shellhaas, C., Conrey, E., Crane, D. et al. The Ohio Gestational Diabetes Postpartum Care Learning Collaborative: Development of a Quality Improvement Initiative to Improve Systems of Care for Women. Matern Child Health J 20 (Suppl 1), 71–80 (2016). https://doi.org/10.1007/s10995-016-2170-2
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DOI: https://doi.org/10.1007/s10995-016-2170-2