Reducing Disparities in Postpartum Care Utilization: Development of a Clinical Risk Assessment Tool.
Sandi Tenfelde, Cara Joyce, Dina Tell and 3 others
PMID 36565235WHAT IT FOUND
Age, timing of first prenatal visit, number of prenatal visits, and parity were associated with missed postpartum care within 84 days in a large community health center cohort.
The tool needs external validation before use to improve attendance.
Key findings
01A 6-variable model comprised of four risk factors was selected: mother's age at first visit, gestational age at first visit, total number of prenatal care visits, and mother's parity.
02The model's ability to separate patients who returned from patients who did not was reported as good, with a c-statistic of 0.73.
03The model has higher net benefit than intervening on all patients for threshold probabilities of 0.2 and greater.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The model was developed from electronic health records and has not been externally validated. The paper gives different non-attendance rates in the cohort description and the Discussion, so the exact rate is unclear. Postpartum visits were captured only in the Federally Qualified Health Center system, so care obtained elsewhere may be missed. Income and employment data were missing for many patients, so those factors could not be used. The sample came from Federally Qualified Health Centers serving low-income populations, so results may not generalize to other settings. Electronic health record data were collected for care and billing, not specifically for this research question.
Declared interests
The authors report no conflict of interest. The paper is listed as supported by NIH extramural research.
The easy way to misread this
Do not conclude that the tool improves postpartum care attendance. It was developed from electronic health records and needs external validation; no intervention was tested.