Improving Postpartum Diabetes Screening in Women with Gestational Diabetes: A Quality Improvement Study at Flushing Hospital Medical Center (Implementation Phase)

Background Women with gestational diabetes mellitus (GDM) are estimated to have a 40-70% risk of developing type II diabetes mellitus in the next 10-20 years, thus rendering postpartum glucose testing an important step in early intervention and management.i The oral glucose tolerance test (OGTT) is preferred over fasting blood glucose and hemoglobin A1c due to its increased sensitivity in detecting glucose intolerance.ii However, studies have found that fewer than 50% of patients with GDM undergo postpartum glucose screening.iii Some quality improvement studies have found an improvement to 60 – 85% rates of screening after intervention. iii Objectives The objectives of our study are 1) to identify the baseline proportion of GDM patients who underwent postpartum OGTT testing, 2) to identify the steps at which the standard of care was not maintained 3) to evaluate the change in proportion after interventions. Methods The first intervention involves changing the template used by clinicians for postpartum visits to include two questions: 1) did this patient have gestational diabetes in this pregnancy, and 2) if yes, was the 2-hour glucose challenge test ordered? The second intervention involves adding information to patient discharge instructions about their next postpartum visit appointment and a reminder to complete their 2-hour glucose challenge test during that visit. Results Our baseline percentage of postpartum glucose screening over the past six months was 59.38 %. From chart review, we identified that out of the patients who did not get postpartum glucose screening, 38.5% were due to patient loss to follow-up before their postpartum visit, 38.5% due to the provider forgetting to order the test, and 23.1% due to patient inability to complete the test. Current Status Implementation of the first intervention is underway; data collection is underway on rates of postpartum glucose testing.