Referral to Telephonic Nurse Management Improves Outcomes in Women With Gestational Diabetes

Abstract

Objective We sought to determine whether, among women with gestational diabetes mellitus, referral to a telephonic nurse management program was associated with lower risk of macrosomia and increased postpartum glucose testing. Study Design There was medical center–level variation in the percent of patients referred to a telephonic nurse management program at 12 Kaiser Permanente medical centers, allowing us to examine in a quasi-experimental design the associations between referral and outcomes. Results Compared with women from centers where the annual proportion of referral nurse management was 70% were less likely to have a macrosomic infant and more likely to have postpartum glucose testing (multiple-adjusted odds ratio, 0.75; 95% confidence interval, 0.57–0.98 and multiple-adjusted odds ratio, 22.96; 95% confidence interval, 2.56–3.42, respectively). Conclusion Receiving care at the centers with higher referral frequency to telephonic nurse management for gestational diabetes mellitus was associated with decreased risk of macrosomic infant and increased postpartum glucose testing.