142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Gestational diabetes mellitus: A case study of failure modes and innovation for diabetes prevention among women

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014 : 11:30 AM - 11:50 AM

Lois McCloskey, DrPH, MPH , Community Health Sciences Department, Boston University School of Public Health, Boston, MA
Judith Bernstein, PhD, RNC , Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
Meryl St. John, MA , Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
Marlena Sherman , Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
Hannah Siegel, MPH , Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
Ronald Iverson, MD , Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA
Gestational diabetes mellitus (GDM) signals future risk for women.  Sixty percent of women with GDM develop type 2 diabetes within the ten years following delivery . However, health systems routinely fail women as they transition from prenataland postpartum care to primary and preventive care. Our study was designed to elucidate failures in the follow-up  of women with GDM, and to test the feasibility of an  innovation, sustainable under the Affordable Care Act (ACA)-supported Patient-Centered Medical Home (PCMH) models. Methods: We conducted in-depth interviews with GDM patients (N=30) and obstetric and primary care providers (N=24) at an urban academic medical center and community health center.  Based on findings, we created a process map, identified key failure modes along the continuum of care, and populated each with narratives to highlight barriers at the systems-, provider-, and patient-levels.  Our findings informed the design of a patient navigator/motivational interview (PN/MI) intervention to improve postpartum glucose testing and successful transition to primary care.  Results: Key failure modes occur at diagnosis, referral to nutritionists, discharge summaries, postpartum visits, and communication of glucose test results to patients and primary care providers. Patients seek relief from ‘bad sugar’, a debilitating disease in their communities; providers balance reassurance and risk as they counsel patients; and electronic records are insufficient carriers of prenatal information to primary care providers. It is feasible to incorporate PN/MI in prenatal care to prepare women for ongoing self- care and prevention of future chronic illness. Conclusions: PCMH, to be successful for women of reproductive age, must include innovations that bridge prenatal and primary care.

Learning Areas:

Chronic disease management and prevention
Clinical medicine applied in public health
Implementation of health education strategies, interventions and programs
Public health or related nursing
Public health or related research

Learning Objectives:
Identify the failure modes that characterize the follow-up care for women with a history of gestational diabetes mellitus. Discuss specific provider-, patient-, and systems-level barriers to ongoing care and self-care for women following a GDM pregnancy. Describe the importance of establishing a Patient-centered Medical Home innovation to bridge pregnancy and primary care for women.

Keyword(s): Primary Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am Associate Professor of Community Health Sciences at Boston University School of Public Health. I serve as PI of the NICHD grant upon which the research is based.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.