Among women with gestational diabetes mellitus, referral to a telephone-based nurse management program was associated with lower risk of high baby birth weight and increased postpartum glucose testing, according to Kaiser Permanente researchers.

Investigators for the Kaiser Permanente Northern California Division of Research examined the associations between referral to telephone-based nurse consultation and outcomes in 12 Kaiser Permanente medical centers with variation in the percent of patients referred to telephonic nurse management.

“Compared with women from Kaiser Permanente medical centers where the annual proportions of referral to nurse management at the Kaiser Permanente Regional Perinatal Service Center was less than 30 percent, women who delivered in medical centers with an annual referral proportion of greater than 70 percent were less likely to have a high birth weight infant without increasing the risk or having a low birth weight infant,” said Assiamira Ferrara, MD, PhD, a research scientist with the Kaiser Permanente Northern California Division of Research and the lead author of the study. “In addition, they were more likely to have postpartum glucose testing, which leads to earlier identification and management of postpartum glucose intolerance or diabetes.”

The study appears online in the American Journal of Obstetrics and Gynecology.

Investigators used data from the Kaiser Permanente Northern California GDM registry to identify women who had pregnancy complicated by GDM from 1997 through 2006. They restricted their cohort to women with GDM according to the National Diabetes Data Group criteria. During the study period, 96 percent of all pregnant women without preexisting diabetes who delivered an infant were screened for GDM. Researchers excluded women who delivered multiple births due to their increased risk of perinatal complications. Overall, researchers identified 11,435 women with GDM at the 12 medical centers, of whom 44.5 percent were referred to the perinatal service center.

“The Kaiser Permanente Regional Perinatal Service Center is a nurse-based management program for women with GDM that offers supplemental care via telephone counseling to women with high-risk pregnancies, including those complicated by GDM,” explained co-author Monique Hedderson, PhD, a research scientist with the Kaiser Permanente Northern California Division of Research.

The program includes a call center with 32 registered nurses and two registered dieticians who offer phone counseling seven days a week and address glucose monitoring and control, diet and physical activity. Nurses are available 24 hours a day, seven days a week, while dieticians are available to patients during the week from 8 a.m. to 5 p.m. In addition to care provided by obstetricians, women referred to the center receive one to two counseling calls per week to help them manage their blood glucose levels during pregnancy. The center also sends a laboratory slip for postpartum glucose testing and a reminder telephone call if the screening test was not performed.

The Kaiser Permanente Regional Perinatal Service Center GDM program was first implemented in 1997 in two medical centers and gradually disseminated to 12 more centers. By 2006, the program was implemented in all Kaiser Permanente medical centers.

“Due to the timeline for program implementation, there was some medical-center level variation in the percent of patients referred to the program,” said Dr. Ferrara. “This allowed us to develop a quasi-experimental design to examine the association between referral to the program and infant adverse outcomes (infant high and low birth weight) and to measure processes such as patient postpartum glucose testing.”
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Additional authors on the study included Jenny Ching, RN, and Yvonne M. Crites, MD, both with the Kaiser Permanente Regional Perinatal Service Center based in Santa Clara, Calif.; Tiffany Peng, MA, with the Kaiser Permanente Division of Research; and Catherine Kim, MD, MPH, with the departments of medicine and obstetrics gynecology at the University of Michigan, Ann Arbor.

The study was supported by funds from the Translating Research into Action for Diabetes study, which was supported by the Centers for Disease Control and Prevention and by grants from the National Institute of Diabetes and Digestive and Kidney Diseases.

About the Kaiser Permanente Division of Research

The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large. It seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 500-plus staff is working on more than 250 epidemiological and health services research projects.

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services to improve the health of our members and the communities we serve. We currently serve more than 9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health.

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