Objective To estimate whether postpartum visit attendance was improved in women exposed to a postpartum patient navigation program compared with those who received care immediately prior to the program's initiation, and to assess whether other postpartum health behaviors improved during the intervention period. Methods This is a prospective observational study of women enrolled in a patient navigation program compared to women receiving care prior to the program. Navigating New Motherhood was a postpartum patient navigation program for adult, English-speaking women receiving prenatal care at a Medicaid-based university clinic. In 2015, Navigating New Motherhood introduced a clinic-level change in which a navigator was hired and assumed supportive and logistical responsibilities for enrolled patients between delivery and postpartum visit completion. We compared medical record data from women who enrolled in Navigating New Motherhood to those of women receiving care in the same clinic for one year immediately prior to Navigating New Motherhood. The primary outcome was postpartum visit attendance. Secondary outcomes included WHO Tier 1 or 2 contraception uptake and other health services measures. We conducted bivariable and multivariable analyses. Results Of the 225 women approached for Navigating New Motherhood participation after program initiation, 96.9% (N=218) enrolled; these women were compared to 256 women in the historical cohort. Most women on both groups were racial or ethnic minorities and all had Medicaid insurance. There were no important differences in demographic, clinical, or health services characteristics between groups, though women in Navigating New Motherhood were more likely to transfer into the clinic for prenatal care and to deliver babies admitted to the NICU. The primary outcome, return for postpartum care, was more common among women in Navigating New Motherhood (88.1% vs. 70.3%, p<0.001), a difference that persisted after adjustment for potential confounding factors (aOR 3.57, 95% CI 2.11-6.04). Women in Navigating New Motherhood also were more likely to receive a WHO Tier 1 or 2 contraceptive method (aOR 1.56, 95% 1.02-2.38), postpartum depression screening (aOR 2.82, 95% CI 1.79-4.43), and influenza (aOR 2.10, 95% CI 1.38-3.19) and HPV vaccination (aOR 2.33, 95% CI 1.25-4.33). Conclusions Implementation of a postpartum navigation program was associated with improved retention in routine postpartum care and frequency of contraception uptake, depression screening, and vaccination.

Patient navigation is a patient-centered intervention that uses trained personnel to identify patient-level barriers, including financial, cultural, logistical, and educational obstacles to health care and then mitigate these barriers to facilitate complete and timely access to health services. For example, to assist a woman with Medicaid who is seeking postpartum care, a patient navigator could help her schedule an appointment before her insurance benefits change, coordinate transportation and child care, give her informational pamphlets on contraception options, and accompany her to the appointment to ensure her questions are answered. Existing studies examining the efficacy of patient navigation interventions show particularly striking benefits in the realm of cancer care, including gynecological oncology; patient navigation has been demonstrated to increase access to screening, shorten time to diagnostic resolution, and improve cancer outcomes, particularly in health disparity populations, such as women of color, rural populations, and poor women. Because of the successes in cancer care at reducing disparities in health care access and health outcomes, patient navigation has the potential to improve care and reduce disparities in obstetric and benign gynecological care. We review the concept of patient navigation, offer potential roles for patient navigation in obstetrics and gynecology, and discuss areas for further investigation.

Gestational diabetes mellitus (GDM) poses well-established risks to both the mother and infant. As over 50% of women with GDM will develop type 2 diabetes mellitus (T2DM) in their lifetime, performing postpartum oral glucose tolerance testing (OGTT) is paramount to initiation of appropriate lifestyle interventions and pharmacologic therapy. Nonetheless, test completion among women with GDM is estimated to be <50%, with particularly low rates in Latina patients, as well as patients with public insurance, low education levels, and low health literacy. Data suggest our current health services infrastructure loses patients in the postpartum gap between pregnancy-focused care and primary care. As previous studies have demonstrated strategies to promote OGTT completion for T2DM prevention, hereto is a proposal of best practices including 1) enhanced patient support for identifying long-term health care providers 2) patient-centered medical home utilization when possible 3) patient and provider test reminders, and 4) formalized obstetrician-primary care provider hand-offs using the “SBAR” (Situation Background Assessment Recommendation) mnemonic. These strategies deserve future investigation to solidify a multi-level approach for identifying and preventing the continuum of diabetes.

Objective This study was aimed to assess patient and provider perceptions of a postpartum patient navigation program. Study Design This was a mixed-method assessment of a postpartum patient navigation program. Navigating New Motherhood (NNM) participants completed a follow-up survey including the Patient Satisfaction with Interpersonal Relationship with Navigator (PSN-I) scale and an open-ended question. PSN-I scores were analyzed descriptively. Eighteen provider stakeholders underwent in-depth interviews to gauge program satisfaction, perceived outcomes, and ideas for improvement. Qualitative data were analyzed by the constant comparative method. Results In this population of low-income, minority women, participants (n = 166) were highly satisfied with NNM. The median PSN-I score was 45 out of 45 (interquartile range [IQR]: 43–45), where a higher score corresponds to higher satisfaction. Patient feedback was also highly positive, though a small number desired more navigator support. Provider stakeholders offered consistently positive program feedback, expressing satisfaction with NNM execution and outcomes. Provider stakeholders noted that navigators avoided inhibiting clinic workflow and eased clinic administrative burden. They perceived NNM improved multiple clinical and satisfaction outcomes. All provider stakeholders believed that NNM should be sustained long-term; suggestions for improvement were offered. Conclusion A postpartum patient navigation program can perceivably improve patient satisfaction, clinical care, and clinic workflow without burden to clinic providers.

OBJECTIVE: To compare communication between navigators and women according to followup status in a postpartum patient navigation program ("Navigating New Motherhood" [NNM]). METHODS: This is a mixed methods secondary analysis of text message and email transcripts from NNM. Transcripts were analyzed by number of messages sent, received, and unanswered. Message themes were qualitatively analyzed using constant comparative technique. Bivariable and multivariable tests were conducted. RESULTS: Most women (98.2%) communicated with navigators via text message. Women who completed postpartum follow-up sent and received more texts than women who did not (7.8 vs. 3.7, p<0.001 and 11.5 vs. 8.0, p<0.05, respectively); exchange of ≥6 messages was associated with greater odds of follow-up (adjusted odds ratio 2.89, 95% CI1.13-7.41). Lack of patient response was also associated with lack of follow-up (p<0.001). Four categories of message themes were identified: Rapport-building, Postpartum Care Coordination, Maternal Health, and Motherhood. Message threads with more Rapport-building or Maternal Health messages were associated with more frequent patient follow-up (p<0.01 and p<0.05, respectively), as was average number of emoticons per message thread (2.1 vs. 1.2, p=0.01). CONCLUSION: More frequent and multidimensional communication was associated with follow-up in a postpartum patient navigation program.