Closing gaps in postpartum care: the IMPACT study
March 22, 2024
Meeting patients’ postpartum care needs is an ongoing challenge in the U.S. Many patients face challenges after giving birth, such as having stable housing, health care coverage, and transportation to provider’s appointments.
Dealing with these social determinants of health (SDOH) – nonmedical factors that influence health outcomes – makes it difficult to recover from childbirth and identify, let alone manage, serious chronic or pregnancy-related conditions such as high blood pressure, diabetes, and depression.
Sometimes, SDOH gaps in care result in tragedy. Maternal deaths nearly doubled in the U.S. over three years, from 754 in 2019 to 1,205 in 2021. Black pregnant individuals are at more than twice the risk compared with white pregnant individuals. In Texas, 61% of maternal deaths in 2020 happened between six weeks and a year after delivery – after the typical window of postpartum care ends.
As health care providers, we owe it to our patients to gather information and resources that will help reduce pregnancy-related health problems.
In 2021, a team from UT Southwestern and Parkland Health launched the extending Maternal Care After Pregnancy (eMCAP) program to connect recently delivered patients with postpartum high blood pressure and diabetes care for a full year instead of the standard 60 days after delivery.
Rather than the traditional expectation of patients presenting to the hospital for care, the eMCAP program’s goal was to reset the expectation and meet patients where they live. Through telemedicine and mobile health care units, we brought health services and education to the patients in their local communities. This initiative was unique because we intentionally placed patients at the center of their care, asking questions about barriers to traditional postpartum services and specific SDOHs they face.
Early successes of eMCAP are exceeding our expectations. Patients with high blood pressure had significantly better follow-up through the full year, and patients with diabetes showed improvement through three months, resulting in much lower blood sugar levels in the postpartum period.
Now, we’re using results from the ongoing eMCAP program to jumpstart a next-level research initiative, the Improving Maternal Postpartum Access to Care through Telemedicine (IMPACT) study. With funding from the nonprofit Patient-Centered Outcomes Research Institute (PCORI), we are studying whether telemedicine or smartphone push notifications work best to deliver patient care and education, overlaid with insights directly from patients.
'By addressing the specific barriers postpartum patients face in Dallas-Fort Worth, data from the IMPACT study can help improve health outcomes and reduce disparities in maternal care in ways that are relevant and important to our patients.'
How SDOHs affect maternal care
Through eMCAP, patients share specific barriers to optimum postpartum health. Among the chief concerns is transportation, such as not having a car, gas money, or access to public transportation. According to the American Hospital Association, 3.6 million people forgo medical care each year due to transportation barriers[.
Getting timely and consistent prenatal care can help reduce pregnancy complications, especially among patients with preexisting conditions. In Texas, pregnant individuals may be able to get free health coverage during their pregnancy through Medicaid for Pregnant Women and the Children’s Health Insurance Program (CHIP) Perinatal initiative. However, not everyone is aware such programs exist, and people are often afraid of the cost of accessing care.
Unconscious or intentional racial bias can also contribute to increased mortality rates for marginalized communities. Patients from underrepresented minorities face three to five times as many pregnancy complications compared with white pregnant persons. Dallas is a diverse city, with 24% of the population identifying as Black and 42% as Latino. For the eMCAP program, every team member completed training in culturally and linguistically appropriate services for maternal care to expand the aperture of our collective lens on this issue.
Another concern is low health literacy. People with limited health care knowledge may not recognize postpartum risks, such as excessive vaginal bleeding or signs of depression.
While patients may have barriers to transportation and childcare, smartphone usage is almost ubiquitous among patients. It is an underutilized way to reach patients, both to provide education and deliver virtual health care.
Related reading: PeriPAN: Getting pregnant and postpartum women mental health care faster
About the IMPACT study
IMPACT is designed to be a research initiative and a targeted intervention for patients with health conditions – today and long term. The study will take place at Parkland Memorial Hospital in Dallas and Grady Memorial Hospital in Atlanta. It will focus on recently delivered patients who are at high risk for postpartum complications, such as those with high blood pressure, diabetes, and cesarean deliveries.
Starting March 1, 2024, IMPACT will be conducted over five years in two phases. The first year will focus on observation to solidify our understanding of the SDOH gaps our patients face. In phase two, patients will be randomized into two groups:
- Group one will receive extensive discharge instructions and educational push notifications delivered to their phone, which will cover timely information about their health and ways to access expert care.
- Group two will receive normal discharge instructions and access to serialized telemedicine appointments.
Patients in each group will be followed for a year by a team of dedicated providers and researchers from the Patient-Centered Outcomes Research Institute (PCORI) who will help us build a database to assess patients’ mental health, diabetes, and blood pressure outcomes after a year. It also will measure which communications channels they preferred and which worked best to manage postpartum health conditions and reduce hospital and emergency department visits.
This study is uniquely patient-centered. Patients helped create the study structure and will have access to results in real time. They can have a voice throughout the study by giving feedback at the point of care and participating on our advisory board.
UTSW and Grady Memorial plan to host community events throughout the study to help patients feel connected to IMPACT and its findings. We are also working with a medical illustrator to create infographics and mailings to enhance health literacy and share our data.
By addressing the specific barriers postpartum patients face in Dallas-Fort Worth, data from the IMPACT study can help improve health outcomes and reduce disparities in maternal care in ways that are relevant and important to our patients. Through community engagement and transparent communication of findings, we hope to help close gaps in maternal care associated with social determinants of health.
To schedule an appointment for prenatal or postpartum care, call 214-645-8300 or request an appointment online.
