Programs effective for reducing postpartum hospitalizations

Programs effective for reducing postpartum hospitalizations | Image Credit: © JYPIX - © JYPIX - stock.adobe.com.

According to a recent study published in the American Journal of Obstetrics & Gynecology, postpartum hospitalizations and racial disparities in postpartum hospitalizations may be reduced by a program which identifies and solves social and clinical needs.

Severe maternal morbidity (SMM) and maternal mortality rates are greater in the United States than other nations with a similar national investment in healthcare. Significant racial and ethnic disparities in maternal deaths have also been reported in the United States. Hypertension (HTN), a leading indicator of SMM, is seen twice as often in Black women than any other racial or ethnic group.

Many SMM cases develop after women leave the hospital. Therefore, maternal outcomes and disparities may be improved through postpartum navigation in which a mother works with their provider to navigate barriers to care.

Postpartum navigation is associated with improved quality of life, further supporting the need to develop postpartum navigation programs. To evaluate the association between postpartum navigation programs and 30-day postpartum hospitalization admissions, investigators conducted a retrospective cohort study.

Records of women with a significant SMM risk who delivered at 3 hospitals in the New York Metropolitan region from April 2020 to November 2021 were collected. The program evaluated was the Northwell Health’s Maternal Outcomes (MOMs) program, which was created to reduce disparities and poor outcomes among women with a high SMM risk.

Individuals were selected for enrollment into MOMs through a data algorithm determining risk of SMM based on International Classification of Diseases, Tenth Revision (ICD-10) codes. Program criteria and referral instructions were detailed in a 1-page document.

Postdelivery discharge care was managed by a multidisciplinary team of care management coordinators, nurse practitioners, and registered nurses. Participants received 30 days of care management following delivery. 

The procedure began with a phone call 24 hours after discharge where discharge instruction and medications were discussed, and a care plan was developed. After 48 hours, a second phone call was conducted to ensure adherence to the care plan.

Following the initial 2 phone calls, participants received a call weekly throughout the 30-day program. These calls made up 2 to 3 hours of consultation with a navigator. Women most likely to be hospitalized according to LACE index scores, which could be used to measure rehospitalization risk, were prioritized to receive this care.

Further risk factors were identified using evidence-based postpartum screening tools. Navigators developed plans for patients to receive follow-up care or specialty care as needed. Patient adherence and utilization was tracked in real time.

There were 19,258 deliveries occurring at the study hospitals during the study period, 30.2% of which involved mothers at a higher risk of SMM during delivery. These patients were included in the final analysis, and 45.6% received navigation. 

Most women enrolled were aged 18 to 40 years old, and 76.9% were not Hispanic or Latino. HTN was the most common risk condition observed at discharge, seen in 54.5% of patients.

The initial call was received by 91% of enrolled patients, with 80% of these patients completing the 30-day program. The incidence of hospitalization within the 30 days after delivery was 20% less in women enrolled in the program compared to women not enrolled, at a rate of approximately 16 fewer hospitalizations per 1000 patients.

Black women experienced a more significant rate of hospitalization reduction, with Black women enrolled having a reduction of 43% compared to Black women not enrolled. Hypertensive disorders of pregnancy were the most common reasons for rehospitalization based on ICD-10 codes, seen in 71.6% of rehospitalization cases.

These results indicated reduced rates of hospitalization for SMM among women enrolled in the MOMs program, with racial disparities successfully addressed. Investigators recommended cost analyses be conducted to inform the value basis for postpartum navigation programs.

Reference

Brown Z, Messaoudi C, Silvia E. Postpartum navigation decreases severe maternal morbidity most among Black women. American Journal of Obstetrics & Gynecology. 2023;229(2):160.E1-160.E8. doi:10.1016/j.ajog.2023.01.002