Implementation of an Order Set Prior to Delivery Discharge for Postpartum Glucose Testing in Gestational Diabetes: Gaps in Follow-up and Opportunities for Improvement

Abstract

To explore continuing factors contributing to noncompletion of the postpartum (PP) 75-g oral glucose tolerence test (75-gr, 2-hour OGTT) of patients with gestational diabetes (GDM) after minimizing provider factors by implementing an automatic order set in the electronic medical record. This study also evaluated how well results and counseling of results were communicated to patients.

From December 2019 to April 2023, 490 pregnancies with GDM were assessed for completion of 75-gr, 2-hour OGTT during postpartum period. Data were collected into an Excel sheet and deidentified before statistical analysis.

During the study period, 57% of eligible patients completed the 75-gr, 2-hour OGTT. Noncompletion rates were highest in the following groups: African American (59.3%), teenage group (55%), BMI > 40 (46%), and hypertension group (50.5%). Among those who failed to complete the test, patient factors were the major contributors; 48% did not return for postpartum follow-up, while approximately 32% had the test ordered but did not complete it. Patients diagnosed with T2DM were notified of their results in 100% of cases, while patients with impaired glucose tolerance were informed 92% of the time. Normal results were communicated to 64% of patients. Appropriate counseling was documented in the abnormal results group; however, the group with normal results had the highest non-communication rate, and no counseling on future surveillance was documented.

The automatic order set resulted in 57% completion, an increase of 16% from the historical completion rate prior to the study. Patient factors were the main contributor to noncompletion, highlighting continued barriers to healthcare at the patient level not directly addressed in this study. Communication of results was satisfactory with abnormal results but unsatisfactory when results were normal, representing missed opportunities for counseling on long-term follow-up. Even though this study demonstrated an increase in overall completion rate, this study identifies groups at risk and barriers to noncompletion. Implementation of targeted immediate postpartum testing in groups at risk of noncompletion may close this gap.