Comparing a Model of Augmented Postpartum Primary Care to Usual Care in an Urban Medical Center.

Abstract

Background: The US faces a maternal health crisis and struggles to deliver recommended postpartum care. In some populations, less than half of mothers attend a postpartum visit.

Objective: To determine if a two-generation (Two-Gen) model of interdisciplinary, postpartum primary care was associated with increased visit attendance for postpartum care, primary care, and behavioral health.

Design: Retrospective study of care delivered at a single, urban, academic, safety-net medical center between 2020 and 2023.

Participants: Mothers who received postpartum care in Two-Gen and a comparison group who received usual postpartum care.

Main measures: Adjusted logistic regression to estimate the effect of Two-Gen participation on the odds of attending an early (birth-to-3 weeks) postpartum visit, later (4-to-12 weeks) postpartum visit, OB/GYN visit, and primary care visit.

Key results: A total of 247 mothers (98 Two-Gen and 149 usual care) were included for analysis. Most identified as Non-Hispanic Black (55%) or Hispanic (34%) and had Medicaid insurance (74%). On average, Two-Gen mothers were younger and more likely to be primiparous. Compared to usual care, Two-Gen mothers had similar rates of early postpartum visits (79% vs 64%; adjusted odds ratio (aOR) 1.70; 95% confidence interval (CI) 0.92-3.14) and were significantly more likely to have a later postpartum visit (92% vs 79%; aOR 2.46; 95%CI 1.06-5.74) in adjusted analyses. Almost all Two-Gen mothers (97%) had a visit with a primary care doctor in the first postpartum year, compared to 19% of mothers receiving usual care (aOR 12.95; 95%CI 6.80-24.68). Of those with behavioral health diagnoses, Two-Gen mothers had higher rates of psychiatrist visits than usual care mothers (49% vs 13%; p = 0.001).

Conclusions: Two-Gen clinic participation was associated with high rates of timely postpartum care in a group of predominantly young, publicly insured, racial, and ethnic minority mothers and compared favorably to usual care across multiple metrics, notably utilization of primary and behavioral health care.