Increasing postpartum screening in women with gestational diabetes at risk for developing type two diabetes mellitus

Abstract

Background: Women diagnosed with Gestational Diabetes Mellitus (GDM) in pregnancy have a significantly increased risk of developing Type 2 Diabetes Mellitus (T2DM) within 5-10 years postpartum. Despite recommendations by the American Diabetes Association (ADA) and the American College of Obstetrics and Gynecology (ACOG) to screen for T2DM using a 2-hour 75g glucose tolerance test (gtt) within 4-12 weeks postpartum, national adherence rates remain below 60%, This quality improvement (QI) project sought to address this gap by enhancing screening rates at a women's specialist clinic in southwest Montana. Methods: A 6-week provider-focused QI project was implemented to improve the identification and postpartum screening of patients with GDM. Interventions included staff education, the creation and utilization of a universal smart phrase in the electronic health record (EHR), and revisions to nursing workflow sheets. Weekly chart audits and qualitative interviews were conducted to evaluate staff adherence and ease of implementation. Results: Among 154 postpartum patients reviewed during the study period, 3.9% (n=6) had a GDM diagnosis. The percentage of patients who received the recommended 2-hour 75g gtt increased from 54% to 83% (n=5) following the interventions. However, the utilization of the universal postpartum smart phrase was recorded in only 16% of cases. Qualitative interviews suggested that staff education and workflow sheet updates were more impactful than the smart phrase in improving guideline adherence rates. Conclusion: While the project successfully increased postpartum screening rates for T2DM, the universal smart phrase was underutilized due to staff preferences and workflow habits. Future QI initiatives should focus on integrating automated EHR prompts, extending project timelines, and addressing long-term adherence through ongoing staff education, screening for previous GDM diagnoses in primary care, and patient follow-up for adherence to screening. These efforts are critical to reducing the burden of chronic disease in populations at elevated risk for T2DM.