Improving Patient-Centered Postpartum Care Planning and Coordination Within a Federally Qualified Health Center

Inadequate postpartum care coordination may contribute to preventable maternal morbidity and mortality and misses a crucial opportunity to engage patients in their care after giving birth. More than half of pregnancy-related deaths occur between one week and one year postpartum, and health disparities are consistently observed for marginalized populations. The optimization of providing postpartum care must prioritize a person-centered approach and support the transition back to primary care in order to improve maternal health outcomes.

A rapid-cycle quality improvement initiative was implemented over 8 weeks in a federally qualified health center serving a population with predominantly low risk medical needs. At baseline, only 53% of clinic patients attended a postpartum visit within 3 weeks of birth, and none had a care plan in place to facilitate the transition back into primary care. This initiative aimed to improve the patient experience of fourth trimester care planning and engagement to a mean score of 5 (from a baseline of 4.3 on a 6-point scale) on the modified 9-item Shared Decision Making Questionnaire (SDM-Q-9) in 8 weeks. Care coordination using a pregnancy care passport and a fourth trimester registry were implemented to support patient-centered engagement, evidence-based care, and to track outcomes related to care coordination progress.

Engagement in postpartum care planning as a shared decision-making experience improved to a mean score of 5.8 on the SDM-Q-9 in eight weeks. The registry demonstrated a statistically significant improvement in fourth trimester visit scheduling and attendance (P <.05), with the largest gains noted in the use of lactation services.

This initiative employed patient-centered postpartum care planning and coordination to improve patient satisfaction, engagement, and access to health care services in the postpartum period, using tools that can be adapted for other settings. Future projects should explore the use of these interventions in higher-risk populations.