Postpartum Visit Timing and the Effect on Visit Attendance
Condition: Postpartum Disorder; Postpartum Depression; Postpartum Weight Retention; Breastfeeding; Satisfaction, Patient; Trust
MeSH terms: Depression, Postpartum; Puerperal Disorders; Gestational Weight Gain
Study type: Interventional

Summary: 
      The objective of this study is to assess if the addition of an early postpartum visit
      improves attendance at postpartum visits. We seek to evaluate if an additional early
      postpartum visit improves patient education, satisfaction, or trust in the clinicians during
      the postpartum period; all of which may ultimately facilitate improved outcomes.
      Additionally, we seek to explore patient preferences for postpartum care delivery.
    

Detailed description: 
      Maternal mortality in the United States is currently at a record high of 17 deaths per
      100,000 live births and the majority of pregnancy related deaths occur in the postpartum
      period due to complications from chronic disease exacerbation, pregnancy-related
      hypertension, or psychiatric conditions that lead to suicide. Optimal postpartum care would
      reduce mortality risk, but numerous studies have demonstrated current care is inadequate. Up
      to 40% of women do not attend their postpartum visit at 4-6 weeks after delivery and the
      15-minute visit is too short to achieve the comprehensive goals that the American College of
      Obstetricians and Gynecologists (ACOG) sets for this visit: a full assessment of physical,
      social, and psychological well-being. In addressing the current gap between optimal and
      actual care, ACOG recently recommended that practitioners shift from the standard, single
      six-week postpartum visit to two postpartum visits, the first within three weeks of delivery.
      While this change is intended to address current sub-optimal outcomes, the effects of this
      change are entirely unknown.

      The long term goal of our program is to improve postpartum care for women in Rhode Island.
      The primary objective of this project is to determine if the ACOG proposed additional
      postpartum visit within three weeks of delivery improves attendance to postpartum
      appointments compared to routine postpartum care. Additionally, we intend to examine whether
      having two scheduled postpartum visits (one within three weeks and the other at the standard
      4-6 week postpartum time point) which we describe as "early and often" postpartum
      care-improves patient knowledge, satisfaction and trust in clinicians compared to routine
      care as well as explore patient preferences for postpartum care. Our central hypothesis is
      that early and often postpartum care will lead to improved patient visit attendance compared
      to routine care.
    

Intervention name(s): Early postpartum visit; Standard postpartum visit
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The early postpartum visit will be an in-person visit with a medical provider at 14-21 days postpartum.; The standard postpartum visit will occur at 35 to 56 days postpartum.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention