Multi-modal Interventions to Increase the Postpartum Screening Rates for Type 2 Diabetes After Gestational Diabetes: A Focus on a Vulnerable Population

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Introduction/Purpose: The diagnosis of gestational diabetes (GDM) predicts type 2 diabetes (T2DM) development. The 2-hour glucose tolerance test (GTT) is the recommended test to screen for T2DM in the postpartum (PP). The purpose of this quality improvement is to increase the postpartum screening rates for T2DM. Research shows vulnerable populations are under-studied, guidelines are confusing, barriers create challenges, multi-modal interventions increase rates, and alternate testing methods needed. Methods: Four interventions specific to this population were used to improve screening rates: a flyer, a PowerPoint slide, PP visit scheduled with the 2-hour GTT, SMS appointment and 2-hour GTT reminder. The Self-Efficacy for Diabetes questionnaire assessed self-efficacy and was uploaded into the patient portal. Five reports were compiled pre-and post-intervention and compared: number of women with GDM, number of 2-hour GTT ordered and completed, insurance type, and due date. Self-Efficacy for Diabetes questionnaire assessed self-efficacy prior to and after the GDM class. Results: A paired samples t-test determined if self-efficacy increased after the GDM class and visits. The mean difference was statistically significant with the p-value < .001. A Pearson Chi-Square test of independence was used to determine if multi-modal interventions improved the screening. Screening rates significantly increased from pre-intervention (8.14%) to post-intervention (26.3%) p-value = 0.001. The attrition rate improved from 92% to 73.6% post-intervention. Discussion: Screening rates improved significantly for MMC. The Self-Efficacy for Diabetes questionnaire scores indicated the GDM class significantly improved self-efficacy. However, screening rates remain suboptimal.

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gestational diabetes, postpartum screening, interventions, type 2 diabetes, vulnerable populations, Community health services--Barrier-free design
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