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Team‐Based Approach to Managing Postpartum Screening of Women with Gestational Diabetes for Type 2 Diabetes
Author(s) -
Bounds Faye L.,
Rojjanasrirat Wilaiporn,
Martin Mary A.
Publication year - 2021
Publication title -
journal of midwifery and women's health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.543
H-Index - 62
eISSN - 1542-2011
pISSN - 1526-9523
DOI - 10.1111/jmwh.13202
Subject(s) - medicine , gestational diabetes , guideline , type 2 diabetes , obstetrics , diabetes mellitus , pregnancy , diabetes in pregnancy , gynecology , family medicine , gestation , endocrinology , genetics , pathology , biology
Approximately 6% of pregnant women develop gestational diabetes mellitus (GDM), which is a strong risk factor for developing type 2 diabetes mellitus. It is recommended that women with GDM complete a 75‐g oral glucose tolerance test (OGTT) 4 to 12 weeks postpartum to screen for type 2 diabetes. A 3‐month retrospective chart review in 2 patient‐centered medical homes found that postpartum screening for type 2 diabetes was performed in only 39% of eligible women, despite recommendations from the American College of Obstetricians and Gynecologists (ACOG) and the American Diabetes Association. Thus, a quality improvement project was initiated to improve the postpartum type 2 diabetes screening rate. Process This quality improvement project involved an education session that described current ACOG recommendations for diabetes screening. The education session included a pretest and posttest that evaluated participants’ understanding about development of type 2 diabetes after GDM. A team‐based postpartum guideline designed to enable women to complete a 75‐g OGTT at the 4‐to‐12‐week postpartum appointment was implemented. A postintervention chart review was conducted to determine the postintervention rate of type 2 diabetes screening. Outcome The mean pretest score for the clinical team was 57%, and the mean posttest score was 99%. Postpartum screening for women with GDM was improved from 39% of women for whom screening was indicated to 77% with the implementation of the team‐based guideline. Discussion The quality improvement project results demonstrated that improved understanding of ACOG recommendations combined with the implementation of a team‐based guideline significantly improved postpartum screening for type 2 diabetes. Team‐based management of care, including education of team members about the rationale for change, may also improve outcomes in other quality improvement projects.