INTRODUCTION:
Nearly 40% of women do not attend their postpartum visits. Attendance rates are even lower in underserved populations. Increasing patient participation, especially in communities of low resources, involves a multi-faceted approach in care coordination. We highlight a bundle of systems changes implemented by three Los Angeles County Department of Health Services (LAC DHS) hospitals to improve the rates of postpartum visits.
METHODS:
We collected baseline data on postpartum visits for women who delivered in the LAC DHS from July 2016 to June 2017. A bundle of interventions were implemented throughout the health system including: 3rd trimester scheduling of postpartum visits, appointment confirmation on day of discharge after delivery for both 3-week and 6-week visits, congratulations calls with appointment reminders at 1 week post-delivery, reminder calls the day before appointments, and coordinating pediatric visits at discharge with existing maternal appointments. During the bundle implementation year, data collection continued and performance improvement was assessed at 6 months and 1 year after baseline assessment. Services were identified by CPT, ICD-9-CM and ICD-10-CM codes.
RESULTS:
Six months following baseline, 47% (n=753) of patients attended postpartum visits. One year following baseline, 58% (n=954) of patients attended. There was a statistically significant difference chi-square (1, N=3,251)=36.11, P<.001, with a 60% improvement in follow-up rates.
CONCLUSION:
Increased postpartum return rates in resource-limited setting can be achieved through coordinated efforts. Performance improvement teams can utilize a bundle of structured activities and track change through rapid cycle improvement initiatives.
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