Despite the importance of postpartum visits, rates of follow up after delivery remain low among publicly insured patients. This improvement project addressed postpartum visit completion in an urban resident clinic.METHODS:
Using quality improvement methods, we identified three gaps in the postpartum follow up process: communication between delivering and postpartum providers, patient knowledge, and appointment scheduling. These gaps informed focused interventions. We instituted electronic health record tools for improved discharge communication, delivery tracking and postpartum lab orders (ie, glucose tolerance tests [GTTs]—for gestational diabetics). Postpartum visit education materials were developed and distributed to patients. Visit scheduling was improved with telephone reminders and expansion of the follow-up timeline. The primary outcome measure—proportion of completed postpartum visits—was collected monthly. The proportion of GTTs completed was a secondary outcome. Process measures were tracked to assess fidelity of interventions. Analytic techniques included statistical process control and bivariate tests for significance (chi-square, two-sample t test).RESULTS:
At baseline, the monthly postpartum visit completion averaged 65.3% over nine months, with all observations within control limits. The proportion of completed visits increased to 77.3% after four months of implementation (P=.057 compared to baseline mean). GTT completion rates increased from 30.8% to 75.0%. 82.3% of patients received telephone scheduling reminders post-intervention. The appropriate postpartum provider was directly notified of delivery for only 21.3% of patients.CONCLUSION:
Tailored interventions surrounding postpartum discharge processes successfully increased the rate of postpartum visit completion. This model may be adapted to improve follow-up rates in other care settings.