A Team-Based Approach for Improving Postpartum Glucose Screening in Gestational Diabetes Patients [28E]

Abstract

INTRODUCTION: Postpartum testing of gestational diabetes (GDM) patients with an oral 2-hour glucose tolerance test (OGTT) is suboptimal, with national rates ranging from 18-57%. The purpose of this study was to investigate if a standardized workflow supplemented with educational sessions could improve the OGTT screening rate. METHODS: A multi-disciplinary workflow was implemented in two Medicaid clinics in January 2018. Pre-intervention subjects were GDM patients in the 4-12 week postpartum period between March-June 2017, while post-intervention subjects were between January-April 2018. Immediately prior and during the post-intervention time period, the obstetrical team received small-group education sessions on the American College of Obstetricians and Gynecologists (ACOG) GDM guidelines, with re-enforcement of workflow. A pretest and posttest were performed to assess effectiveness. Paired t-test was used to compare the pretest and posttest scores, and chi-square testing was used to compare compliance with screening. IRB approval was obtained for this study. RESULTS: Nineteen out of thirty members (63%) of the obstetric team completed the educational session. Mean pretest score for the team was 57.4%; the mean posttest score was 99.2% (p<0.01). Eighteen patients were in the pre-intervention group, while 26 patients were in the post-intervention group. Postpartum screening of GDM patients improved from 39% to 77% after workflow implementation (p=0.01). CONCLUSION: Educational sessions and standardized workflow interventions utilizing a multi-disciplinary team were associated with improvement in both understanding of the ACOG guidelines and patient compliance with postpartum glucose screening. This team-based approach may be useful in other quality improvement initiatives.