Work

CA6-01: A System-based Intervention to Improve Postpartum Diabetes Screening Among Women with Gestational Diabetes

Year: 2012

Type: article

Abstract: BACKGROUND/AIMS: Postpartum diabetes screening is recommended for women with gestational diabetes (GDM); up to 36.0% of them will have glucose abnormalities after delivery. To improve the <60% rate of postpartum diabetes screening in Kaiser Permanente Northwest, we conducted a multi- faceted process improvement project. METHODS: The intervention included revision of protocols used to guide outpatient care provided to pregnant patients with types 1, 2, and gestational diabetes, and revision of electronic order entry tools; development of an electronic reminder system to trigger phone calls to patients who had not completed postpartum glucose testing within 3 months after delivery; and a series of 60 minute educational sessions for clinicians, nurses, and medical assistants conducted between January and April 2009. The pre-implementation population was GDM-affected deliveries July 1, 2007—June 30, 2008 (n=200) and the post-implementation population was GDM-affected deliveries July 1, 2009— June 30, 2010 (n=179). Two main outcomes were evaluated: 1. clinician orders for either a fasting blood glucose (FBG) test or 2-hr oral glucose tolerance test (OGTT) placed between one month before to 3 months after delivery, and 2. a completed FBG or 2-hour OGTT performed between 14 days after delivery and December 31, 2008 (pre-implementation) or December 31, 2010 (post-implementation). Because patient characteristics did not differ significantly between the pre-and post-implementation populations, an unadjusted Cox Proportional Hazards model was used to evaluate test completion. RESULTS: The prevalence of GDM was 3.8% in pre-(200/5250) and post- populations (179/4765). The proportion of women who received an order for a postpartum glucose test within 3 months of delivery increased from 77.5% (155/200) to 88.8% (159/179) (p=.004); the proportion completing the test Within 3 months of delivery increased from 53.5% (107/200) to 60.3% (108/179) (p=.18). When including tests completed beyond the first 3 months postpartum (through December 2008 pre-and December 2010 post-implementation), women in the post-implementation group had a significantly higher rate of test completion (59.5% [119/200] vs. 71.5% [128/179], p=0.01, Hazards Ratio 1.37, 95% CI 1.07 to 1.7. DISCUSSION: Rates of postpartum diabetes testing among women with recent GDM can be improved with system changes and reminders to women.

Source: Clinical Medicine & Research

DOI: 10.3121/cmr.2012.1100.ca6-01