Gestational Diabetes Collaborative Experiences Demonstrate the Link Between Better Data and Care
Monday, August 31, 2015
Increasing prevalence of gestational diabetes mellitus (GDM), currently estimated at 5%-6%, puts about 240,000 women at risk for developing type 2 diabetes (T2DM) each year.
1. Difficulties in reaching consensus on the prevalence of GDM exist for many reasons: use of various diagnostic criteria, confusion about specific criteria used to diagnose GDM, and lack of documentation of GDM screening, diagnosis and care.
2. Improving the validity of GDM data would increase identification of women with GDM and facilitate provider outreach to ensure patients receive adequate education and treatment. The goals of the GDM Collaborative project were to identify gaps in data quality and documented care and to develop interventions that demonstrate the link between better GDM data and better care.
In 2009, CDC Divisions of Diabetes Translation and Reproductive Health and NACDD Women’s Health Council established a multi-state Collaborative (state and local health departments, hospitals, universities, agencies such as Medicaid, statewide coalitions, private providers and tribes) to inventory routinely collected GDM data sources, identify gaps in data quality and documented care, and develop improvement interventions. Each state Collaborative collected baseline prevalence data, and developed action plans according to state’s needs. This article highlights the documentation and intervention efforts of GDM Collaborative states/tribes and emphasizes the need for other states to replicate these efforts. When the multi-state Collaborative compared GDM prevalence data from Pregnancy Risk Assessment Monitoring System (PRAMS), birth certificates (BC) and maternal medical records data, GDM diagnosis was omitted from 277 of 363 BCs reviewed. The GDM diagnosis was found in 38.2% of linked medical records. Prenatal records showed 26% lacked documented GDM testing and/or follow-up, making a documented diagnosis impossible. Only 5% of medical records documented referral for follow-up care. Utah’s Collaborative implemented system changes to improve transfer of medical records data to BCs, decreasing percent of undocumented GDM cases on BCs by 85%. Increased accuracy of GDM diagnoses on BCs enabled project states to identify more women with GDM deliveries and mail them postpartum testing reminders, increasing postpartum testing by 35%. Several other states replicated these successful activities. Ohio’s GDM healthcare practices survey disclosed that only 45% of providers tested glucose of women with GDM postpartum, and less than 37% correctly identified the high degree of risk of T2DM for women with GDM. Survey results data enabled development of professional education programs and patient education resources by several Collaboratives. West Virginia initiated system changes in a hospital-based prenatal clinic, increasing GDM documentation of testing and diagnosis to 100%, postpartum follow-up by 78%, and glucose testing orders from 10% to 39%. The quests to assess and improve data quality and to initiate system changes in the Tribal Collaborative partnerships led to: enhanced Tribal interface with Women’s clinics, Wellness programs and WIC Clinics; promotion of new/revised Clinical Assessment and Management Guidelines; addition of GDM to Tribal Diabetes Data Registries; development of electronic medical record templates for GDM, post-partum and yearly well women reminders; and development of culturally and literacy appropriate patient brochures, fact sheets, media messaging and magnets. These Collaborative successes demonstrate the need for development of quality improvement processes for GDM data sources both in collection tools themselves, application and analysis. Data from these projects suggest that system changes in data collection result in changes in clinical practices and can improve the quality of GDM care. 1. National Institutes of Health Consensus Development Conference Statement: Diagnosing Gestational Diabetes Mellitus, March 4-6, 2013 2. Owens-Gary M, Ware JL. Interventions to Increase Access to Care and Quality of Care for Women With Gestational Diabetes. Diabetes Spectrum 2012; Volume 25:26-28.