Referral to telephonic nurse management improves outcomes in women with gestational diabetes.
OBJECTIVE
We sought to determine whether, among women with gestational diabetes mellitus, referral to a telephonic nurse management program was associated with lower risk of macrosomia and increased postpartum glucose testing.


METHODS
There was medical center-level variation in the percent of patients referred to a telephonic nurse management program at 12 Kaiser Permanente medical centers, allowing us to examine in a quasi-experimental design the associations between referral and outcomes.


RESULTS
Compared with women from centers where the annual proportion of referral nurse management was <30%, women who delivered from centers with an annual referral proportion >70% were less likely to have a macrosomic infant and more likely to have postpartum glucose testing (multiple-adjusted odds ratio, 0.75; 95% confidence interval, 0.57-0.98 and multiple-adjusted odds ratio, 22.96; 95% confidence interval, 2.56-3.42, respectively).


CONCLUSIONS
Receiving care at the centers with higher referral frequency to telephonic nurse management for gestational diabetes mellitus was associated with decreased risk of macrosomic infant and increased postpartum glucose testing.
Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA. Assiamira.Ferrara@kp.org
Assiamira
A
Ferrara
Monique M
MM
Hedderson
Jenny
J
Ching
Catherine
C
Kim
Tiffany
T
Peng
Yvonne M
YM
Crites
D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D016640:Diabetes, Gestational / Q000451:nursing*; D037001:Directive Counseling / Q000379:methods; D005260:Female; D005320:Fetal Macrosomia / Q000209:etiology / Q000517:prevention & control; D005951:Glucose Tolerance Test / Q000706:statistics & numerical data; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016015:Logistic Models; D016017:Odds Ratio; D011181:Postnatal Care / Q000379:methods*; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012042:Registries; D017216:Telemedicine / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
D001786:Blood Glucose