Development of a Clinical Risk Assessment Tool for 6-Week Postpartum Visit Nonadherence

Qafiti, Fred N; Kaur, Sangeeta; Bahado‐Singh, Ray O.

doi:10.1055/s-0037-1612640

Cited by 4 publications

(7 citation statements)

References 11 publications

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“…Despite its importance, attendance at postpartum visits varies from 5.7% to 95.4% completion. 26,31 Rates are especially low among individuals of minoritized racial and ethnic groups or those with limited resources, 32,33 despite the disproportionate risk of T2D and CVD. [34][35][36] In addition, individuals with suboptimal prenatal care utilization are less likely to receive postpartum blood pressure screening, 37 suggesting that those with decreased access to prenatal care are less likely to remain engaged in the health care system, compounding existing disparities.…”

Section: Barriers To Postpartum and Long-term Health Care After A Pre...mentioning

confidence: 99%

Improving Postpartum and Long-Term Health After an Adverse Pregnancy Outcome: Examining Interventions From a Health Equity Perspective

DiTosto

Roytman

Dolan

et al. 2022

Clinical Obstetrics &Amp; Gynecology

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Gestational diabetes mellitus and hypertensive disorders in pregnancy are adverse pregnancy outcomes (APOs) that affect 15% of pregnancies in the United States. These APOs have long-term health implications, with greater risks of future cardiovascular and chronic disease later in life. In this manuscript, we review the importance of timely postpartum follow-up and transition to primary care after APOs for future disease prevention. We also discuss interventions to improve postpartum follow-up and long-term health after an APO. In recognizing racial and ethnic disparities in APOs and chronic disease, we review important considerations of these interventions through a health equity lens.

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Section: Barriers To Postpartum and Long-term Health Care After A Pre...mentioning

confidence: 99%

Improving Postpartum and Long-Term Health After an Adverse Pregnancy Outcome: Examining Interventions From a Health Equity Perspective

DiTosto

Roytman

Dolan

et al. 2022

Clinical Obstetrics &Amp; Gynecology

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“…A prior publication simplified beta coefficients into points, therefore losing some precision in the risk estimation. 22 Finally, another advantage of our tool is the ability for easy precise calculations using an online calculator.…”

Section: Model Evaluationmentioning

confidence: 99%

“…The mean (SD) age of the sample was 27 (7.08) years, 40% were married or partnered, and 24% reported being employed. Patients in our sample entered into prenatal care on average at 14 (range, [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] weeks with an average of 10 (range, 5-15) prenatal visits. Using the Kotelchuck index reference described above, 29 41% of patients received inadequate care, 17% received intermediate care, 30% received adequate care, and 12% received adequate plus care.…”

Section: Cohort Characteristicsmentioning

confidence: 99%

“…Consistently, patients of lower socioeconomic status and patients who had public health insurance or Medicaid were less likely to return compared with patients with higher incomes or private insurance. 12,20,22 Many of these patients receive care at Federally Qualified Health Centers (FQHCs), which are community-based health care facilities for underserved populations. The purpose of this study was to develop a clinical decision support tool for identifying patients receiving care at FQHCs who are less likely to return for postpartum care.…”

Section: Introductionmentioning

confidence: 99%

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Reducing Disparities in Postpartum Care Utilization: Development of a Clinical Risk Assessment Tool

Tenfelde

Joyce

Tell

et al. 2022

J Midwife Womens Health

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Introduction Patients receiving care at Federally Qualified Health Centers (FQHCs) have low postpartum care attendance. Perinatal morbidity and mortality disproportionately affect patients with low‐income and are potentially preventable. The purpose of this study was to develop a clinical decision support tool to identify FQHC patients less likely to return for postpartum care. To accomplish this purpose, we evaluated established predictors and novel risk factors in our patient population. Methods This is a retrospective, secondary data analysis of 50,022 patients who received prenatal care past 24 weeks’ gestation in FQHCs between 2012 and 2017. The postpartum visit was defined using Healthcare Effectiveness Data and Information Set measures as early care (birth to 21 days) and later care (21‐84 days). Anderson's Behavioral Model for Access to Healthcare guided inclusion of potentially predictive factors. We stratified data by postpartum care attendance, and a final predictive model was selected by model fit statistics and clinical relevance. Results In our sample, 64% of birthing persons attended postpartum care at FQHCs. Of those who returned for care, 38% returned within 21 days postbirth and 62% returned between 21 and 84 days, with 28% returning for both early and later care. Predictors for postpartum care attendance included maternal age, parity, gestational age at first visit, and number of prenatal care visits. A clinical decision support tool for identifying patients less likely to return for care was created. Discussion An easy to implement clinical decision support tool can help identify FQHC patients at risk for postpartum nonattendance. Future interventions to improve adequacy of prenatal care can encourage early entry into prenatal care and sufficient prenatal visits. These efforts may improve postpartum care attendance and maternal health.

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“…2 Furthermore, these challenges are particularly acute for women without childcare assistance or who are struggling with social or economic instability. 3 Understanding both the importance and the unique challenges of postpartum care is critical as trends in maternal morbidity continue to rise with a concomitant increase in postpartum complications and hospital readmissions. Research has demonstrated increased postpartum readmission rates from 1.72% in 2004 to 2.16% in 2011.…”

mentioning

confidence: 99%

Reducing Disparities Using Telehealth Approaches for Postdelivery Preeclampsia Care

Kern-Goldberger

Hirshberg²

2021

Clinical Obstetrics &Amp; Gynecology

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The management of hypertensive disease of pregnancy presents an ongoing challenge after patients are discharged from delivery hospitalizations. Preeclampsia and other forms of postpartum hypertension increase the risk for severe maternal morbidity and mortality in the postpartum period, and both hypertension and its associated adverse events disproportionately affect black women. With its ability to transcend barriers to health care access, telemedicine can facilitate high-quality postpartum care delivery for preeclampsia management and thereby reduce racial disparities in obstetric care and outcomes. Here we discuss racial disparities in preeclampsia and the challenge of providing equitable postpartum preeclampsia care. We then describe the utility of novel telemedicine platforms and their application to combat these disparities in preeclampsia care.

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Development of a Clinical Risk Assessment Tool for 6-Week Postpartum Visit Nonadherence

Abstract: This risk assessment tool relies on routinely collected data, making its implementation simple. Applying it in the clinical setting allows for early, targeted intervention aimed at minimizing 6WPP nonadherence.

Cited by 4 publications

References 11 publications

Improving Postpartum and Long-Term Health After an Adverse Pregnancy Outcome: Examining Interventions From a Health Equity Perspective

Improving Postpartum and Long-Term Health After an Adverse Pregnancy Outcome: Examining Interventions From a Health Equity Perspective

Reducing Disparities in Postpartum Care Utilization: Development of a Clinical Risk Assessment Tool

Reducing Disparities Using Telehealth Approaches for Postdelivery Preeclampsia Care

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