| Description |
The purpose of this project was to evaluate a large faculty practice, BirthCare HealthCare (BCHC), to determine current processes of postpartum screening of women with gestational diabetes mellitus (GDM), involving the following steps: determine, through chart review, rates of postpartum screening for type 2 diabetes (DM2) in women previously diagnosed with gestational diabetes from April 2011 to December 2012; compare the follow-up screening rates within the practice to the national rate; and present findings to the practice with suggested ways to improve follow-up. Gestational diabetes mellitus, or GDM, is a serious disease that complicates between 2% and 10% of all pregnancies (CDC, 2011a). There are many health consequences to the mother and baby when the mother has GDM including elevated future risk of DM2. Approximately 70% of women with GDM will go on to develop DM2 (Buchanan and Xian, 2011). The annual cost of DM2, and its complications in the United States, is close to $200 billion (Buchanan & Xiang, 2005). According to England et al. (2003), it is estimated that only 18%-64% of childbearing women are receiving the recommended postpartum screening. It is very important that appropriate screening and preventative measures be taken, due to health consequences and high cost. By screening only 18%-64% of these women postpartum we are missing an opportunity for early diagnosis and intervention. Shah et al. (2011) found that postnatal reminders increased follow-up significantly. The study found that postpartum follow-up screening increased from 14% prior to reminders to nearly 60% when both provider and patient received reminders. To accomplish the above objectives a process map was created outlining current practice for diagnosis of and postpartum follow-up with women with GDM. Accuracy of the map was determined by GDM subcommittee member and content expert Jane Dyer, PhD, CNM, FNP, MBA, as well as Kimberly Powell, MS, CNM, WHNP, RN, APRN, content expert and quality improvement committee member. A chart review of all patients who delivered between April 2011 and December 2012 with the diagnosis of GDM was then performed to determine rates of follow-up as well as the demographic of patients. It was found that about 65.6% of women with GDM were receiving appropriate postpartum follow up within the BCHC practice. Most of the women not being screening were white, insured and multiparous. Nearly 82% of those not screened either did not present for postpartum care or did not present to the lab for the test the midwife ordered. Also 23.5% of all women diagnosed with GDM were misdiagnosed, as the women did not meet criteria for diagnosis. All information was then presented to BCHC with suggestions to improve rates. The faculty was open to suggestions of sending follow-up reminders to patients 1-2 weeks prior to the six-week postpartum appointment. They also plan to adhere to more strict guidelines for diagnosing GDM. |
