The Ohio Gestational Diabetes Postpartum Care Learning Collaborative: Development of a Quality Improvement Initiative to Improve Systems of Care for Women
Objectives To improve clinical practice and increase postpartum visit Type 2 diabetes mellitus (T2DM) screening rates in women with a history of gestational diabetes mellitus (GDM). Methods We recruited clinical sites with at least half of pregnant patients enrolled in Medicaid to participate in an 18-month quality improvement (QI) project. To support clinical practice changes, we developed provider and patient toolkits with educational and clinical practice resources. Clinical subject-matter experts facilitated a learning network to train sites and promote discussion and learning among sites. Sites submitted data from patient chart reviews monthly for key measures that we used to provide rapid-cycle feedback. Providers were surveyed at completion regarding toolkit usefulness and satisfaction. Results Of fifteen practices recruited, twelve remained actively engaged. We disseminated more than 70 provider and 2345 patient toolkits. Documented delivery of patient education improved for timely GDM prenatal screening, reduction of future T2DM risk, smoking cessation, and family planning. Sites reported toolkits were useful and easy to use. Of women for whom postpartum data were available, 67 % had a documented postpartum visit and 33 % had a postpartum T2DM screen. Lack of information sharing between prenatal and postpartum care providers was are barriers to provision and documentation of care. Conclusions for Practice QI and toolkit resources may improve the quality of prenatal education. However, postpartum care did not reach optimal levels. Future work should focus on strategies to support coordination of care between obstetrical and primary care providers.
KeywordsGestational diabetes Quality improvement Postpartum care
Clinical subject matter experts: Steven Gabbe MD; Mark Landon, MD; Stephen Thung, MD—The Ohio State University College of Medicine, Division of Maternal Fetal Medicine. Toolkit development: Health Services Advisory Group—Phoenix, Arizona. Pilot sites: Akron Children’s Hospital Maternal Fetal Medicine—Akron, Ohio; Center for Health Services at Promedica—Toledo, Ohio; Cleveland Clinic Foundation, Cleveland, Ohio; Diabetes Wellness Center of Atrium Medical Center—Middletown, Ohio; Madison County Hospital—London, Ohio; Mercer Health Disease Management Clinic—Coldwater, Ohio; Mercy Health Anderson OB/GYN Care Center—Cincinnati, Ohio; OB/GYN Specialists of Lima—Lima, Ohio; Ohio Health O’Bleness Hospital, Athens Medical Associates—Athens, Ohio; Ohio State University Maternal Fetal Medicine—Columbus, Ohio; Ohio State University OB/GYN Clinics—Columbus, Ohio; Pickaway Health Center of Berger Health Systems—Circleville, Ohio; Summa Health System—Akron, Ohio; University of Cincinnati Medical Center—Cincinnati, Ohio; University Hospitals MacDonald Women’s Hospital—Cleveland, Ohio.
The Ohio Office of Health Transformation.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
- American College of Obstetricians and Gynecologists. (2013). Practice bulletin number 137: Gestational diabetes mellitus. Obstetrics and Gynecology, 122(Supplement 2 Part 1), 406–416.Google Scholar
- Bardenheier, B. H., Imperatore, G., Gilboa, S. M., Geiss, L. S., Saydah, S. H., Delvin, H. M., … Gregg, E. W. (2015). Trends in gestational diabetes among hospital deliveries in 19 U.S. states, 2000–2010. American Journal of Preventive Medicine, 49(1), 12–19.CrossRefPubMedPubMedCentralGoogle Scholar
- Care Coordination. (content last updated July 2016). At Agency for Healthcare Research and Quality, Rockville, MD online. Retrieved from http://www.ahrq.gov/professionals/prevention-chronic-care/improve/coordination/index.html.
- Centers for Disease Control and Prevention. (2014). National diabetes statistics report: Estimates of diabetes and its burden in the United States, 2014. Accessed November 10, 2015, from http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf.
- Gunderson, E. P., Hurston, S. R., Ning, X., Lo, J. C., Crites, Y., Walton, D., … Quesenberry, C. P. (2015). Lactation and progression to type 2 diabetes mellitus after gestational diabetes mellitus: A prospective cohort study. Annals of Internal Medicine, 163(12), 889–898.CrossRefPubMedGoogle Scholar
- Ko, J. Y., Dietz, P. M., Conrey, E. J., Rodgers, L., Shellhaas, C., Farr, S. L., & Robbins, C. L. (2013b). Strategies associated with higher postpartum glucose tolerance screening rates for gestational diabetes mellitus patients. Journal of Women’s Health, 22(8), 681–686.CrossRefPubMedPubMedCentralGoogle Scholar
- Langley, G. L., Moen, R., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd Ed.). San Francisco, CA: Jossey-Bass Publishers.Google Scholar
- Oza-Frank, R., Bouchard, J., Conrey, E., Shellhaas, C., & Weber, M.B. (2015). Health care experiences of low-income women with gestational diabetes and suggestions for improving care [abstract]. Diabetes, 64(Supplement 1), A672.Google Scholar
- Oza-Frank, R., Shellhaas, C., Wapner, A., & Conrey, E. (2011). Gestational diabetes in Ohio: 2006–2008. Ohio Department of Health. Accessed November 10, 2015, from https://www.odh.ohio.gov/~/media/ODH/ASSETS/Files/prams%20-%20pregnancy%20risk%20assessment%20monitoring%20program/Reports%20and%20Fact%20Sheets/ohiogdm_databook_oct_2011.pdf.
- Ratner, R. E., Christophi, C. A., Metzger, B. E., Dabelea, D., Bennett, P. H., Pi-Sunyer, X., … The Diabetes Prevention Program Research Group. (2008). Prevention of diabetes in women with a history of gestational diabetes: Effects of metformin and lifestyle interventions. Journal of Clinical Endocrinology and Metabolism, 93(12), 4774–4779.CrossRefPubMedPubMedCentralGoogle Scholar
- Vesco, K. K., Dietz, P. M., Bulkley, J., Bruce, F. C., Callaghan, W. M., England, L., … Hornbrook, M. C. (2012). A system-based intervention to improve postpartum diabetes screening among women with gestational diabetes. American Journal of Obstetrics and Gynecology, 207(4), 281–286.CrossRefGoogle Scholar
- Weber, M. B., Bouchard, J., Conrey, E., Shellhaas, C., & Oza-Frank, R. (2015). Type 2 diabetes screening, risk and prevention among low-income women with a history of gestational diabetes [abstract]. Diabetes, 64(Supplement 1), A674.Google Scholar