Impact of an intensive follow-up program on the postpartum glucose tolerance testing rate.
OBJECTIVE
Gestational diabetes mellitus (GDM) is a strong risk factor for the development of diabetes. We assessed the impact of a 1-year intensive follow-up demonstration program, using direct nurse and outreach worker case management, aimed at increasing compliance with postpartum oral glucose tolerance testing (OGTT).


METHODS
During the year of implementation, a nurse or bilingual outreach worker contacted patients to encourage attendance at their scheduled postpartum 2-h 75-g OGTT and assisted in overcoming obstacles to testing. All patients with GDM seen in our specialty clinic the previous year served as a control group for comparison.


RESULTS
One hundred eighty-one patients treated during the year prior to implementation were compared to the 207 in the demonstration program. Baseline characteristics were similar in both groups. After the program's implementation, postpartum OGTT adherence increased from 43.1 to 59.4 % (p < 0.01, hazard ratio 1.59; 95 % confidence interval 1.20-2.12). Had the program been in place the previous year, we calculated that 12 additional cases of diabetes or prediabetes would have been detected, increasing the total number from 33 to 45 such cases.


CONCLUSIONS
Implementation of direct nurse and outreach worker case management leads to a modest, but important increase in adherence to postpartum OGTT testing.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, UT Health Science Center at Houston, 6431 Fannin MSB 3.286, Houston, TX, 77030, USA, Hector.R.Mendezfigueroa@uth.tmc.edu.
Hector
H
Mendez-Figueroa
Julie
J
Daley
Pauline
P
Breault
Vrishali V
VV
Lopes
Virginia
V
Paine
Dona
D
Goldman
Mary Jean
MJ
Francis
Blanca
B
Delgado
Donald R
DR
Coustan
D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D003150:Community Health Workers; D003266:Continuity of Patient Care; D003920:Diabetes Mellitus / Q000175:diagnosis; D016640:Diabetes, Gestational / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006801:Humans; D009511:New England / Q000453:epidemiology; D009741:Nursing Staff, Hospital; D010044:Outpatient Clinics, Hospital; D010349:Patient Compliance / Q000706:statistics & numerical data*; D049590:Postpartum Period; D011236:Prediabetic State / Q000175:diagnosis; D011247:Pregnancy; D015397:Program Evaluation; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015406:Single Parent; D012907:Smoking / Q000453:epidemiology