Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Consensus Guideline Implementation Note-Taking (caregiver)

Intervention Description: Four core interventions were created for this project. The population health management registry tracked postpartum patients for early postpartum follow‐up. Patients who were 1–3 weeks postpartum were placed on the registry. Two providers (nurse‐midwife and OB/ GYN physician) called patients to ensure they were progressing as expected, with complications referred for either an in‐person office visit or for urgent evaluation in Labor & Delivery or the Emergency Department. The electronic postpartum note template guided review and documentation of ACOG's recommended visit components for postpartum visits. Clinic staff and providers were educated regarding the use of the tools. No incentive was provided for tool use.

Intervention Results: The project aimed to increase the frequency of effective postpartum care visits from 0% to 80% in 8 weeks. The frequency of effective postpartum care visits was 88% by the end of PDSA Cycle 4. The PRATs increased patient postpartum warning sign knowledge, with a project mean risk factor knowledge score of 6 (Goal = 5). The population health registry drove right care by ensuring early postpartum patients were recovering as expected, as seen by a project mean right‐care score of 16 (Goal = 12). The note template increased the effectiveness of postpartum visits, with a mean effective postpartum care score of 10 (Goal = 10).

Conclusion: The Postpartum Readiness and Awareness Tools (PRAT), population health registry, and note template tools improved quality and postpartum care effectiveness over 8 weeks. It is suggested that the PRAT and note template be sustained to increase anticipatory guidance and adherence to postpartum counseling guidelines. It is also recommended that pre‐scheduled telemedicine visits be implemented for early postpartum follow‐ up. Continued tool utilization can increase patient knowledge of postpartum warning signs, early postpartum follow‐up, and comprehensive 6‐week postpartum visits. Further studies are needed to examine the impact of the interventions on clinic‐ specific patient postpartum morbidity and mortality and differ- ences by race.

Study Design: Quality improvement project consisting of four rapid Plan-Do-Study-Act (PDSA) cycles

Setting: Ob/gyn practice in a large academic hospital in the eastern U.S.

Population of Focus: Postpartum patients

Sample Size: 188 patients

Age Range: Childbearing age

Intervention Components (click on component to see a list of all articles that use that intervention): Note-Taking (caregiver) CAREGIVER Education/Training (caregiver) Educational Material (caregiver)

Intervention Description: A pilot randomised controlled trial was conducted with postpartum mothers to assess the feasibility and impact of note-taking during newborn teaching. Controls received standard teaching; the intervention group received pen and paper to take notes.

Intervention Results: Mothers in the intervention group were more likely than those in the control group to report placing their infant on their back for sleep (88% vs. 78%), but the difference was not statistically significant (RR=1.13, 95% CI: 0.95-1.34). However, first-time mothers were significantly more likely to report placing their infant on the back for sleep (95% vs. 65%, RR=1.46, 95% CI: 1.06-2.00).

Conclusion: Maternal note-taking is feasible and potentially efficacious in promoting desirable infant care.

Study Design: RCT

Setting: Postpartum ward of an urban safetynet hospital

Population of Focus: Mothers on the postpartum ward (infant gestational age >35 weeks, no prolonged hospitalization of the mother or the infant, expecting to retain custody of the infant)

Data Source: Mother report

Sample Size: Intervention (n=61/48) Control (n=65/58)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY Notification/Information Materials (Online Resources, Information Guide) CAREGIVER Note-Taking (caregiver)

Intervention Description: Exposure to environmental tobacco smoke at home increases the risk for numerous diseases in childhood. In this study we asked if maternal tobacco consumption can be reduced by a written advice of the paediatrician.

Intervention Results: Following the written advice of the paediatrician mothers reduced their consumption of tobacco products according to their own information as well as according to the concentrations of cotinine. Confronting mothers with their initial concentrations of cotinine was not found to be an additional factor reducing tobacco consumption.

Conclusion: Maternal consumption of tobacco products can be reduced significantly by an advice of the paediatrician at least for a short time.

Study Design: RCT

Setting: Pediatric clinic

Population of Focus: Mothers attending participating pediatric practice and self-reporting smoked at least 10 CPD

Data Source: Urine samples of the mothers in order to measure the concentrations of the nicotine metabolite cotinine.

Sample Size: 40 mothers

Age Range: Not specified