Novel Clinical Navigation System to Improve Prenatal Care for Patients With Diabetes in Pregnancy [27D

Abstract

INTRODUCTION: Treatment of diabetes in pregnancy requires coordination of resources by obstetric providers. In a high volume, high acuity, low resource academic practice with multiple providers, gaps in care can occur. The Louisiana State University Obstetric Clinic (LSU-OBGYN Clinic) developed a navigation system to guide patients with diabetes through prenatal and postnatal care. We aimed to test the effectiveness of the LSU-Diabetes Navigation System (LSU-DNS) to improve adherence to ACOG standard of care treatment of diabetes in pregnancy. METHODS: We conducted a retrospective cohort study with LSU-OBGYN Clinic patients with diabetes in pregnancy (10/2015–09/2019; n=191). Receipt of ACOG recommended standard of care treatment of patients with diabetes in pregnancy (assessed by: receipt of diabetes education, Maternal Fetal Medicine consultation, growth ultrasounds, weekly fetal monitoring, postpartum glucose testing, and attendance to prenatal appointments) was evaluated before (n=148) or after (n=43) implementation of the LSU-DNS using Fisher exact and Wilcoxon Signed-rank tests. RESULTS: In our cohort, 60 (31%) patients had preexisting diabetes (n=15 Type 1 DM; n=45 Type 2 DM) and 131 (69%) had gestational diabetes. Patients were on average 31±6 years old with a mean body mass index of 37.0±8.7 kg/m2. 49.7% were African American and 90.0% used government-assisted health insurance. Overall adherence to standard of care was significantly improved with the LSU-DNS (before LSU-DNS 78±15% compliance vs. after LSU-DNS 86±13% compliance; P=.0002), and all individual metrics significantly improved except for prenatal appointment attendance. CONCLUSION: A clinical navigation system for management of diabetes in pregnancy improves adherence to standard of care guidelines.