Gestational Diabetes Experiences: Demonstrating the Link Between Better Data and Better Care

BACKGROUND:  Gestational diabetes mellitus (GDM) prevalence is increasing, currently estimated at 5%-6%, putting about 240,000 women at risk for developing type 2 diabetes (T2DM) annually.  Difficulties in documenting and 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 diagnosis and care.  Valid data would increase identification of women with GDM and facilitate provider outreach to ensure women receive adequate education.  The objective of this project is to identify gaps in data quality and documented care and develop interventions that demonstrate the link between better GDM data and better care. 

METHODS:  A multi-state Collaborative (health departments, hospitals, universities, agencies such as Medicaid, statewide coalitions, private providers and tribes) was established to inventory routinely collected GDM data sources, identify gaps in data quality and documented care, and develop improvement interventions. Each Collaborative collected baseline prevalence data, and developed action plans, according to state’s needs.

RESULTS:  Results highlight efforts of four GDM projects. When the multi-state Collaborative compared birth certificate (BC) and maternal medical records data, GDM diagnosis was omitted from 38% of the 277 BCs reviewed, although the diagnosis was found in 62% of linked medical records.  Prenatal records showed 26% lacked documented GDM testing and/or follow-up.  Only 5% of medical records documented referral for follow-up care.  Utah’s Collaborative implemented improvement processes to transfer medical records data to BCs, decreasing percent of undetected GDM cases on BCs by 85%.  Increased accuracy of GDM diagnoses on BCs enabled Utah to identify more women with GDM deliveries and mail them postpartum testing reminders, increasing postpartum testing by 35%.  Ohio’s 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 enabled development of professional education programs.  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%.

CONCLUSIONS:   These findings demonstrate need for development of quality improvement processes for GDM data sources both in collection tools themselves and the collection tool guidance.  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.