Using a Patient Navigator to Improve Postpartum Care in an Urban Women's Health Clinic

Abstract

Objective To estimate whether postpartum visit attendance was improved in women exposed to a postpartum patient navigation program compared with those who received care immediately prior to the program's initiation, and to assess whether other postpartum health behaviors improved during the intervention period. Methods This is a prospective observational study of women enrolled in a patient navigation program compared to women receiving care prior to the program. Navigating New Motherhood was a postpartum patient navigation program for adult, English-speaking women receiving prenatal care at a Medicaid-based university clinic. In 2015, Navigating New Motherhood introduced a clinic-level change in which a navigator was hired and assumed supportive and logistical responsibilities for enrolled patients between delivery and postpartum visit completion. We compared medical record data from women who enrolled in Navigating New Motherhood to those of women receiving care in the same clinic for one year immediately prior to Navigating New Motherhood. The primary outcome was postpartum visit attendance. Secondary outcomes included WHO Tier 1 or 2 contraception uptake and other health services measures. We conducted bivariable and multivariable analyses. Results Of the 225 women approached for Navigating New Motherhood participation after program initiation, 96.9% (N=218) enrolled; these women were compared to 256 women in the historical cohort. Most women on both groups were racial or ethnic minorities and all had Medicaid insurance. There were no important differences in demographic, clinical, or health services characteristics between groups, though women in Navigating New Motherhood were more likely to transfer into the clinic for prenatal care and to deliver babies admitted to the NICU. The primary outcome, return for postpartum care, was more common among women in Navigating New Motherhood (88.1% vs. 70.3%, p<0.001), a difference that persisted after adjustment for potential confounding factors (aOR 3.57, 95% CI 2.11-6.04). Women in Navigating New Motherhood also were more likely to receive a WHO Tier 1 or 2 contraceptive method (aOR 1.56, 95% 1.02-2.38), postpartum depression screening (aOR 2.82, 95% CI 1.79-4.43), and influenza (aOR 2.10, 95% CI 1.38-3.19) and HPV vaccination (aOR 2.33, 95% CI 1.25-4.33). Conclusions Implementation of a postpartum navigation program was associated with improved retention in routine postpartum care and frequency of contraception uptake, depression screening, and vaccination.

Barriers and Facilitators to Recurrent Preterm Birth Prevention among Low-Income Women: A Qualitative Study

“…27,28 Patient navigation has improved attendance at postpartum visits compared with a historical cohort who did not receive navigation, suggesting applicability to obstetrics, such as for pregnant women who are recommended 17P. 20,29 Additionally, as comprehensive postpartum care represents an ideal opportunity to optimize postpartum health and educate patients about subsequent risks and preventive care, patient navigation for postpartum women with a PTB may be an opportunity to leverage identified facilitators and address barriers to future PTB prevention. 18 Beyond patient navigation, clinicians may use the findings herein to implement several other strategies to improve uptake of and adherence to PTB prevention strategies.…”

Multivariable Analysis of the Association between Antenatal Depressive Symptomatology and Postpartum Visit Attendance

“…Enrollment in the postpartum navigation program was associated with enhanced postpartum care uptake and frequency of contraception use, vaccination, and depression screening. 36 Whether these interventions are particularly beneficial to women with antenatal depressive symptomatology should be actively explored.…”

Optimizing postpartum care for the patient with gestational diabetes mellitus

“…Work by our group on patient navigation suggested that concerted efforts to decrease patient logistical barriers to making and attending postpartum appointments is associated with improved postpartum attendance. 32 However, common patient feedback in this program included the desire for coordinated maternal-newborn care. To address these needs, one strategy is the patient-centered medical home (PCMH), a model which revolves around preventive care and coordination of care.…”

“…52 Similarly, our patient navigation program increased postpartum follow-up rates from 70.3% to 88.1% (p<0.001), but there was no statistically significant increase in OGTT completion. 32 A 2012 Kaiser Permanente study, however, sought to combine appointment reminders with other systems processes. 53 The nursing protocol was revised to allow nursing staff to order the tests, and nurse care managers were encouraged to make at least one postpartum reminder call.…”