An Enhanced Postpartum Transition Program to Primary Care.

Area of Science:

• Obstetrics and Gynecology
• Cardiovascular Disease Prevention
• Primary Care Medicine

Background:

• Gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) increase future cardiovascular disease (CVD) risk.
• Postpartum care transitions to primary care clinicians (PCPs) are often inadequate for these high-risk individuals.
• Improved postpartum cardiovascular health monitoring is essential for early risk identification and management.

Purpose of the Study:

• To develop and pilot an enhanced postpartum referral pathway for patients with GDM or HDP.
• To facilitate timely transitions of care to PCPs within 13 months postpartum.
• To improve cardiovascular health screening rates in the postpartum period.

Main Methods:

• A pilot program at an academic medical center implemented an enhanced referral pathway for eligible patients lacking a PCP.
• Referrals were made by clinicians during antenatal, delivery, or postpartum visits.
• A dedicated scheduler facilitated appointment booking with women's health-focused PCPs; outcomes compared referred vs. non-referred patients.

Main Results:

• Of 129 referred individuals, 48.1% attended a PCP visit, 31.8% had cholesterol screening, and 41.9% had HbA1c screening within 13 months.
• Referred individuals showed significantly higher odds of PCP visits (aOR=6.0), cholesterol screening (aOR=2.4), and HbA1c screening (aOR=2.5) compared to non-referred patients.
• The enhanced pathway demonstrated a positive association with improved postpartum follow-up and screening.

Conclusions:

• An enhanced postpartum PCP referral pathway is effective in increasing follow-up care and cardiovascular screenings for high-risk birthing individuals.
• This intervention supports critical postpartum monitoring for women with GDM or HDP.
• Implementing such pathways can improve long-term cardiovascular health outcomes in this population.