Care utilization and clinical outcomes among high-risk patients enrolled in a postpartum navigation program: a...

The postpartum period represents the highest risk time for maternal morbidity and mortality. Patient navigation is a promising intervention to improve maternal outcomes during this high-risk period.

To compare care utilization and clinical outcomes pre- and post-implementation of a postpartum navigation program in a retrospective, matched cohort analysis.

Pregnant patients >32 weeks' gestation at risk for postpartum morbidity were invited to participate in a postpartum navigation program between October 2023 and September 2024. Qualifying criteria included intrapartum complications, hypertensive disorders of pregnancy, diabetes, and/or risk factors for perinatal mood and anxiety disorders. The navigator conducted regular check-ins with enrolled patients at delivery, 2, 6, and 12 weeks postpartum to assess physical recovery and psychological health. A matched cohort was created with similarly high-risk patients who delivered in the 18 months before program implementation and received standard care. Subjects were matched 1:1 according to race, ethnicity, parity, delivery method, and high-risk criteria. We compared adherence to standard postpartum care recommendations and clinical outcomes between the matched groups. Program feasibility and acceptability were assessed using retention and patient satisfaction as endpoints.

Of the 365 patients who met the eligibility criteria, 167 agreed to participate. Five patients withdrew from the program prior to starting any program activities, and one did not have outcome data available. The 161 patients who remained enrolled were matched to historical controls, totaling a final sample size of 322 patients. All demographic and clinical characteristics were similar between the two groups except for gestational age at delivery, which was earlier in the control group (38.7 weeks, IQR 37.4-39.3) than the intervention group (39.0, IQR 37.7-39.6, P=.047). Total attendance at a comprehensive postpartum visit within 12 weeks of birth did not differ (93.8% vs. 90.1%, P=.22). After adjusting for gestational age at delivery, the intervention group was more likely to complete postpartum depression screening (AOR 1.65, 95% CI 1.02-2.67) and continue breastfeeding at 6 weeks postpartum (AOR 2.17, 95% CI 1.46-5.01). The intervention group had higher rates of enrollment in a remote hypertension monitoring program (98.5% vs. 89.1%, P=.027), which recommends once-daily blood pressure (BP) monitoring for two weeks postpartum. Intervention participants also recorded a higher total number of BP measurements using the monitoring program (12 BPs [IQR 0-26] vs. 0 [IQR 0-2], P<.001). However, enrollment in remote monitoring did not remain statistically significant in the multivariate model. Regarding intervention retention, 80.7% of participants attended the 2-week check-in, and 48.4% completed the full program. Ninety-one navigation participants (56.5%) completed a final satisfaction survey: 96.7% indicated they would participate in the program again in the future, and 100% would recommend the program to a pregnant friend or family member.

While attendance at a comprehensive postpartum visit was similarly high before and after implementation of a postpartum navigation program, navigation was associated with improvement in key components of postpartum care, namely hypertension monitoring, breastfeeding duration, and mental health screening.