title: Original research: postpartum testing rates among women with a history of gestational diabetes--systematic review.
abstract: OBJECTIVE
  Gestational diabetes mellitus (GDM) is increasing and 30% have persistent postpartum dysglycemia. Reported compliance with recommended postpartum testing ranges 9-95% without a clear explanation for this wide variation. Small and conflicting differences in testing rates are associated with some demographics (race, use of insulin), but system factors likely play a larger role. A systematic literature review was performed to identify system based factors that could explain the broad variation in postpartum GDM testing rates.
  
  
  METHODS
  Original articles reporting postpartum testing rates among women with GDM were identified within PubMed, OVID, EMBASE, and the Cochrane Database of systematic reviews. Articles that did not report rates for the entire GDM cohort were excluded.
  
  
  RESULTS
  54/307 citations met inclusion criteria. The use of proactive patient contact programs increased postpartum testing rates from an average of 33% (range 9-71%) up to 60% (range 14-95%).
  
  
  CONCLUSIONS
  Proactively contacting patients via phone calls, education programs, or postal reminders was associated with higher postpartum testing rates. Rather than working to identifying individual demographic factors, systems based approaches were associated with a larger potential impact, and appear easily generalizable. Clinicians should think beyond individual habits and consider systematic approaches to improving testing rates.
authors.affiliation: UMDNJ-Robert Wood Johnson Medical School, Jersey Shore University Medical Center, Department of Medicine, Ackerman 3, 1945 Route 33, Neptune, NJ 07753, United States. Electronic address: MPCarson@meridianhealth.com.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Carson
authors.forename: Matthew I
authors.initials: MI
authors.lastname: Frank
authors.forename: Erin
authors.initials: E
authors.lastname: Keely
mesh_terms: D015415:Biomarkers / Q000097:blood; D001774:Blood Chemical Analysis / Q000592:standards; D001786:Blood Glucose / Q000378:metabolism*; D003266:Continuity of Patient Care; D016640:Diabetes, Gestational / Q000097:blood / Q000175:diagnosis*; D005260:Female; D006801:Humans; D011181:Postnatal Care / Q000592:standards; D049590:Postpartum Period / Q000097:blood*; D010818:Practice Patterns, Physicians' / Q000592:standards; D011237:Predictive Value of Tests; D011247:Pregnancy
chemical_list: D015415:Biomarkers; D001786:Blood Glucose
keywords: Gestational diabetes mellitus; Glucose intolerance; Postpartum testing; Pregnancy