Intervention increases postnatal primary care visits among high-risk patients

Key takeaways:

• The proportion of high-risk patients who transitioned to primary care within 6 months of delivery increased from 25% to 72%.
• The intervention also succeeded with minimal funding.

A quality improvement intervention was associated with increased prenatal primary care visits within the first several months after delivery, according to a study published in the Annals of Family Medicine.

According to Jena Wallander Gemkow, MPH, BSN, RN, an associate research scientist from the nonprofit health organization AllianceChicago, and colleagues, maternal mortality rates have continued to rise nationally, particularly among non-Hispanic Black women.

“Consequently, it is critical for birthing people to remain engaged in care the first year postpartum,” they wrote. “There are, however, disparities in the use of preventive care services before and after pregnancy.”

The researchers aimed to address these barriers through a maternal health quality improvement intervention conducted across six federally qualified health centers (FQHCs).

They implemented a registry of high-risk prenatal patients who delivered between January and June of 2021, and created clinical workflows to connect the patients to primary care within 6 months of delivery.

High-risk conditions included pregestational diabetes, depression, gestational diabetes or gestational or chronic hypertension.

Although 50% of the six FCQHs had a criterion for defining high-risk patients and a registry before the intervention, “none had a process documented to coordinate care for high-risk prenatal patients,” Gemkow and colleagues noted.

Overall, the proportion of high-risk patients with a documented primary care visit within 6 months increased from 25% among 102 high-risk patients at baseline to 72% among 134 high-risk patients following the implementation of the intervention.

The proportion of primary care visits within 6 weeks of delivery similarly increased, rising from 83% among 61 patients at baseline to 91% among 96 high-risk patients after the intervention.

“The significant increase in both postpartum and primary care use, with minimal funding, is a key indicator of success, especially considering the context of the COVID-19 pandemic in which health care use, in general, decreased in FQHCs,” the researchers wrote.

They added that registries had been integrated in clinical workflows at 19 sites across all FQHCs by the end of the intervention, and 54 staff members were trained to use the workflows.

The researchers acknowledged several barriers to implementing the intervention, including limited staff for patient outreach and “difficulty following patients through data tracking and [electronic health record] platforms.”

They concluded that the results support maternal quality improvement efforts “and indicate the need for adequate resources for both initial implementation and sustainability.”