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The United States has a maternal mortality crisis. In 2021, 1205 women in this country died of pregnancy-related causes, up from 861 in 2020. Meanwhile, an estimated 80% of these deaths are preventable. Some experts say follow-up care in the year after delivery is critical to monitor for any complications, and primary care clinicians play a critical role during that time.

Medscape Medical News spoke recently with Jena Wallander Gemkow, MPH, BSN, RN, an associate research scientist at AllianceChicago, a nonprofit that collaborates with health centers to advance community health. Gemkow is the corresponding author of a recent study in the Annals of Internal Medicine that examined how to improve postpartum outcomes by implementing better transitions from OB/GYN care to primary care settings.

Staff at six Federally Qualified Health Centers (FQHCs) identified high-risk patients who had pregestational diabetes, gestational diabetes, depression, or gestational or chronic hypertension through chart reviews or electronic health record (EHR) data extraction. These patients were then contacted within 6 months of their delivery. The project developed education for patients about why primary care after delivery was important and what to expect during these visits. The health centers coordinated visits for patients.

After implementation of the intervention, the percentage of 134 high-risk patients completing a primary care visit within 6 months after delivery nearly tripled from baseline to 72% (P < .001).

Question: What motivated you to conduct the study, and what did you learn?

Answer: What motivated us to do the study was the maternal mortality and morbidity crisis that is being experienced across the United States, but is particularly intense in Chicago, where there are significant racial and economic disparities. We have seen a lot of approaches to mitigate these disparities and address this crisis in a lot of various contexts and healthcare settings, but we haven't really seen anything being done in the federally qualified health center setting.

We thought that working with the community-based health centers would be an interesting way to approach this crisis. Our main focus was understanding the transition from postpartum care to primary care.

Q: FQHCs are a unique setting with a larger share of patients who are uninsured or have Medicaid coverage. How might your findings translate to other primary care clinicians who work within larger health systems or private clinics?

A: The transition to primary care from OB care can be pretty fraught. FQHCs are probably not unique in the sense that while the care is integrated as much as possible, there's obviously a potential for loss in follow-up. Communication between the OB providers, the women's health providers, nurse practitioners, back to family care and primary care for continued engagement — I'm not sure that that transition is optimal in most settings. I think it would be great for providers in primary care and in OB to really think about how they can set their patients up for success in the 12 months postpartum, where half of maternal deaths are occurring. There is a lot of intensive work that needs to be done to make this work, but it is worth it in the long run.

Q: Can you point toward steps to improve access and contact after delivery?

A: One thing we talked a lot about with the health centers is improving the communication between the hospital or delivery center and the setting that's providing the prenatal and postpartum care. It can happen a lot of the time that the provider doesn't know that their patient delivered, or they know but don't have all the details. Then they're playing catch-up in that postpartum visit.

That can be pretty critical, especially if the patient had a significant or traumatic event. I think it would be great to see better communication from hospitals to the prenatal and postpartum care settings about the delivery so that providers are really prepared to address whatever their patients are needing in that postpartum visit.

Q: What are some concrete steps primary care clinics can take to identify and reach high-risk patients and improve outcomes? What are some nuts and bolts items that staff and clinicians can do?

A: We really tried hard to make the intervention as successful as possible by making it as low of a lift as possible, really allowing the health center staff and providers to tailor whatever this intervention was going to look like. I don't think anybody needs to be reinventing the wheel. I think a lot of EHRs have the capacity to set this up. Another thing I would recommend would be to talk to their IT department, see what resources are available in their EHRs to set outreaches up, and make them a little bit more automated.

Q: What role does staffing, or lack thereof, play?

A: I think health center leadership or clinic leadership should really consider what their staff are already doing and how they can tailor the workflows that are happening to set these types of processes up. Once they're set up, then it's just more about sustaining them.

Q: Did you gain any insights into patients with less risk for problematic pregnancies? Could the same methods be applied to improve their care as well?

A: I think these processes could be applied to any patient population. In terms of clinic priorities, risk seemed the easiest way to go to start putting this list together.

Q: What would you like to see happen next?

A: There would be a much higher level of interoperability between healthcare systems to optimize the communication between the healthcare systems and then the coordination of care for patients. I would love to see these types of processes happening at a way larger level across clinics, across hospitals, and across health systems.

The study was funded by grants from Merck and the VNA Foundation.

The study authors reported no relevant financial disclosures.

Robert Fulton is a journalist living in California.