Implementation of a Postpartum Note Reminder and Factors Associated with Postpartum Glucose Tolerance Screening

Abstract

Objectives: Although reminder systems are used to increase provider adherence, we are not aware of any real-time reminder systems for provider adherence to postpartum glucose tolerance testing. We studied whether a reminder in the electronic medical records affects provider ordering of a postpartum glucose tolerance test. We also studied whether any demographic, medical history, prenatal, or delivery variables are associated with patient attendance to a postpartum visit and patient completion of the postpartum glucose tolerance test when ordered.Methods: This was a retrospective study of 246 women diagnosed as having gestational diabetes mellitus who completed prenatal care and delivered at a suburban public safety-net hospital.Results: Implementation of the real-time postpartum note reminder system significantly improved provider adherence to postpartum glucose screening recommendations from 58.1% to 75.0% ( P = 0.01). Delivery complications were significantly associated with increased odds for postpartum visit attendance (odds ratio [OR] 3.80, 95% confidence interval [CI] 1.63-8.86, P < 0.01). Increased gestational age at first prenatal visit was significantly associated with decreased odds for postpartum visit attendance (OR 0.93, 95% CI 0.87-0.99, P < 0.05). Speaking Spanish was associated with an increased odds for completion of the postpartum glucose tolerance test when ordered (OR 2.88, 95% CI 1.24-6.70, P = 0.01). Conclusions:We recommend that hospital managers include a reminder system in the electronic medical record. Providers should focus counseling on the potential future risks to the mother, in addition to encouraging continued adherence to postpartum care. Providers also should counsel those who present later to prenatal care about the importance of obtaining postpartum glucose tolerance tests.

Delivery Strategies for Postpartum Care

“…1). We screened 589 full-text articles and included 64 studies (80 articles, 17–96 ) in the current systematic review. Follow-up in the earliest study began in 1989 and in the last study ended in 2021.…”

“…Six studies (four RCTs, two nonrandomized comparative studies) in six articles 34,41,56,69,85,89 addressed screening or preventive care. Two studies addressed who provides care, three addressed care coordination, one addressed information technology use, and two addressed interventions targeting care professionals.…”

“…In terms of interventions targeting screening or preventive care professionals, one RCT (Clark et al 34 ) and one nonrandomized comparative study (Domingo et al 41 ) reported adherence to OGTT (Appendix 12, http://links.lww.com/AOG/D279). Clark et al 34 reported that compared with no reminders, clinician EMR reminders were associated with greater adherence (OR 8.4, 95% CI 2.4–28.5), and so were combined clinician EMR and patient mail reminders (OR 5.2, 95% CI 1.4–19.6).…”

“…Clark et al 34 reported that compared with no reminders, clinician EMR reminders were associated with greater adherence (OR 8.4, 95% CI 2.4–28.5), and so were combined clinician EMR and patient mail reminders (OR 5.2, 95% CI 1.4–19.6). However, Domingo et al 41 reported that compared with no reminders, physician EMR reminders were associated with comparable adherence.…”