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Data to Action Success Story: West Virginia

Using PRAMS Data to Improve Care for Women with Gestational Diabetes in West Virginia

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Problem Overview

Gestational Diabetes Mellitus (GDM) is a disease in which women, who have no history of diabetes, develop hyperglycemia during pregnancy. Gestational diabetes may present with only a few symptoms, and because of this, the disease may go undiagnosed. Often times, GDM is detected by screening pregnant women for the disease. About 3%–5% of pregnant women will develop GDM. Early detection and proper care is crucial, because uncontrolled GDM can lead to pregnancy complications that can affect both mother and baby. These complications include macrosomia (or a large infant), infant jaundice (yellowing of the skin or the whites of the eyes), an increased risk of maternal high blood pressure causing preeclampsia(a pregnancy complication often characterized by a rapid rise in blood pressure that can lead to seizure, stroke, or multiple organ failure), and recurrent GDM during future pregnancies. In patients with GDM, elevated glucose levels return to normal after pregnancy. However, women with GDM are more likely to develop type 2 diabetes later in life. For this reason, women who have had GDM need to receive postpartum screening (even among those women whose glucose levels have returned to normal). Gestational diabetes is a growing concern in West Virginia (WV).

Program Activity Description

In an effort to improve the quality of care for WV women who may develop GDM, several state agencies and stakeholders are collaborating to design a project to identify strengths and weaknesses in the GDM care process. The project, Gestational Diabetes: Better Data, Better Care, has been conducted in phases. Phase 1 (2008–2009) focused on data validation and comparisons from various sources (e.g., PRAMS, birth certificate, hospital charts, records). The findings indicated GDM follow-up procedures needed to improve during prenatal and postpartum (after birth) care; and data quality was lacking because of failure of thorough medical documentation. Phase 2 began in 2010 and used the finding of the first phase to implement a plan of action to improve quality of care and data accuracy at one of West Virginia's largest birthing hospitals. The hospital created a team of several health care professionals who established hospital procedures and policy changes that address the following goals: (1) establish a standard of performance to improve screening for GDM, (2) improve documentation, (3) strengthen patient education, and (4) improve postpartum care. Phase 3 will add missing information.

Program Activity Outcomes

In 2011, one year after implementing these goals and changes, data showed that more women received prenatal screening, and the medical records indicated better documentation of GDM. For example, the first year of collected data showed the number of patients who failed the 1-hour glucose test remained at 18%, but the number of patients who were in compliance with a 3-hour follow-up test increased from 55% to 72%. Results also showed that 100% of patients who were identified by this program had the correct data collection forms and correctly documented diagnosis of GDM in their charts and record. In 2012, the team also implemented an incentive program that is now used to encourage follow-up care compliance. This program provides women with various gifts, such as department store gift cards for continuing follow-up care. In addition, women are educated about the importance of follow-up care, and discharge orders automatically document follow-up visits. The project will expand collaborative efforts between West Virginia health care providers, policy leaders, and other stakeholders. The pilot program will be implemented in other hospitals within the state. Researchers also will review the data sources to determine if documentation and data quality have improved.