Nurse Home-Visiting Program and Postpartum Care

Abstract

According to claims data and medical record reviews, the National Committee for Quality Assurance reported that only 61.8% of Medicaid recipients had a postpartum visit between 21 and 56 days after delivery compared with 76.9% of mothers with commercial insurance. In two Medicaid–self-pay community obstetric clinics in the Piedmont region of North Carolina, the clinics reported that only 52% of their patients returned for their 6-week postpartum visit. At a large birthing facility in the same community, a grant-funded, universal, postpartum, short-term, nurse home-visiting program was developed for all women who gave birth at the facility and their families and who resided in the local county. The evidence-based practice project evaluated the improvement strategies of providing patient education, assuring transportation, and providing an appointment reminder by a postnatal nurse home-visiting program on return rates for the 6-week postpartum visit. A comprehensive literature review was conducted using OVID, PubMed, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases to explore all relevant knowledge and research related to the 6-week postpartum visit to affect return rates and postnatal nurse home-visiting programs. After review of the retrieved articles, 54 were identified to be significant for this project. After creation of an evidence-based educational pamphlet, the postnatal home-visiting nurses and schedulers were trained on providing the educational pamphlet, setting up transportation if needed, and calling patients 2 days before their 6-week visit. First-quarter 2017 preimplementation data and first-quarter 2018 postimplementation data on demographics and return rates were collected and outcomes were compared. The population demographics of age, race, ethnicity, marital status, parity, payor group, and obstetric-provider group for postnatal women who received visits were similar in both groups. In the preimplementation group (n = 172), 91 (52.9%) postnatal women returned for their 6-week postpartum visit. In the postimplementation group (n = 131), 98 (74.8%) postnatal women returned for their 6-week postpartum visit, an increase of 21.9% (p < .001). Improvement of 6-week postpartum return rates can positively affect health, wellness, and contraception use in postpartum women, potentially leading to prevention of unintended pregnancies.