Extending Maternal Care After Pregnancy: An Initiative to Address Health Care Disparities and Enhance Access to Care After Delivery

Problem Definition: A substantial proportion of maternal morbidity and mortality occurs after birth. However, little is known about the optimal design of programs to improve outcomes and decrease disparities during this period. Context: Parkland Health is a tax-supported health system in Dallas that delivers more than 11,000 patients annually. A community needs assessment identified substantial health disparities in this community. The proportion of women in this region with diabetes mellitus (DM) and chronic hypertension (CHTN) during pregnancy is higher than surrounding regions, but access to care in the area is difficult because of the limited availability of ambulatory care. Initial Approach: The authors created extending Maternal Care After Pregnancy (eMCAP), a community-based program, to address health care disparities and enhance access to care for the 12 months after birth. The team also evaluated the ability of Z codes (ICD-10 codes for social determinants of health) to identify patients with health-related social needs. Key Insights and Surprises: The eMCAP program demonstrated improvement in attendance and quality of postpartum care for women living in underserved areas with CHTN and DM. For both CHTN and DM, eMCAP patients were matched 1:2 to controls outside of the eMCAP target region with similar comorbidities for maternal age ± 4 years, Black race, and delivery date ± 45 days. Compared to matched controls who were provided standard referrals, follow-up postpartum attendance for eMCAP women with CHTN was significantly better at 2 weeks and 1, 3, 6, 9, and 12 months (all p < 0.001). Similarly, eMCAP women with DM had significantly better follow-up at 2 weeks (p = 0.04), 1 month (p = 0.002), and 3 months (p = 0.049), resulting in HbA1c values for DM being significantly lower (p < 0.05) throughout the postpartum period. Despite the health system leading in reporting of Z codes, nearly 99% of applicable Z codes were not recorded, underscoring a public health opportunity. Through the eMCAP program, this initiative has demonstrated improved clinical performance for health care outcomes relevant to postpartum patients that can be deployed elsewhere to improve maternal health in underserved communities.