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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Postpartum Visit.

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Strategy. Postpartum Care Plans

Approach. Promote the use of individualized postpartum care plans, co developed by obstetric providers and their patients, that include postpartum visit scheduling

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Overview. Postpartum care guidelines issued by the American College of Obstetricians and Gynecologists encourage obstetrical providers and their expectant patients to co-develop individualized care plans for the postpartum period. Recommended elements of the postpartum plan include care team contact information, a schedule of postpartum visits, a reproductive life plan. (including contraception), mental health anticipatory guidance, and follow-up plans for any pregnancy complications, chronic health conditions, and recovery from postpartum health issues such as stress urinary incontinence.[1,2,3] Tools to help patients and their obstetric providers plan for the postpartum period, including postpartum care plan templates, are available from organizations such as the 4th Trimester ProjectTM at UNC-Chapel Hill, with support from the North Carolina Maternal Health Innovation Initiative.

Evidence. Expert Opinion. Strategies with this rating are recommended by credible, impartial experts, guidelines, or committee statements; these strategies are consistent with accepted theoretical frameworks and have good potential to work. Often there is literature-based evidence supporting these strategies in related topic areas that indicate this approach would prove effective for this issue. Further research is needed to confirm effects in this topic area.

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Consultation (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Individual/Family-Focused

Examples from the Field. There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of obstetric providers trained on developing individualized postpartum care plans in collaboration with their patients. (Measures the provider engagement and capacity building efforts)
  • Number of expectant patients who receive education and support in co-developing their individualized postpartum care plans with their obstetric providers. (Measures the patient engagement and preparation for postpartum care)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Number of obstetric providers trained on developing individualized postpartum care plans in collaboration with their patients. (Measures the provider engagement and capacity building efforts)
  • Number of expectant patients who receive education and support in co-developing their individualized postpartum care plans with their obstetric providers. (Measures the patient engagement and preparation for postpartum care)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of expectant individuals supported by Title V who report feeling engaged, informed, and supported in the process of co-developing their individualized postpartum care plans with their providers. (Measures the patient-centeredness and experience of the strategy)
  • Number of postpartum individuals supported by Title V who report high satisfaction, readiness, and confidence in managing their postpartum health and well-being based on their individualized care plans. (Measures the patient-reported outcomes and experience of the strategy)

OUTCOME MEASURES:

  • Number of healthcare systems and payers that demonstrate improved postpartum care quality, patient experience, and cost savings through the widespread adoption of individualized postpartum care plans. (Measures the healthcare value and return on investment of the strategy)
  • Number of communities and states that achieve significant and sustained improvements in postpartum care utilization, maternal health outcomes, and patient satisfaction through the scaled implementation of individualized postpartum care plans. (Measures the population health and well-being impact of the strategy)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of expectant individuals supported by Title V who report feeling engaged, informed, and supported in the process of co-developing their individualized postpartum care plans with their providers. (Measures the patient-centeredness and experience of the strategy)
  • Percent of postpartum individuals supported by Title V who report high satisfaction, readiness, and confidence in managing their postpartum health and well-being based on their individualized care plans. (Measures the patient-reported outcomes and experience of the strategy)

OUTCOME MEASURES:

  • Percent of healthcare systems and payers that demonstrate improved postpartum care quality, patient experience, and cost savings through the widespread adoption of individualized postpartum care plans. (Measures the healthcare value and return on investment of the strategy)
  • Percent of communities and states that achieve significant and sustained improvements in postpartum care utilization, maternal health outcomes, and patient satisfaction through the scaled implementation of individualized postpartum care plans. (Measures the population health and well-being impact of the strategy)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Phillips, S. E. K., Celi, A. C., Wehbe, A., Kaduthodil, J., & Zera, C. A. (2023). Mobilizing the fourth trimester to improve population health: interventions for postpartum transitions of care. American journal of obstetrics and gynecology, 229(1), 33–38. https://doi.org/10.1016/j.ajog.2022.12.309.
[2] ACOG Committee Opinion No. 736: Optimizing Postpartum Care https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/optimizing-postpartum-care Mentions anticipatory guidance and postpartum care plan.
[3] Stuebe, A. M., Kendig, S., Suplee, P. D., & D'Oria, R. (2021). Consensus Bundle on Postpartum Care Basics: From Birth to the Comprehensive Postpartum Visit. Obstetrics and gynecology, 137(1), 33–40. https://doi.org/10.1097/AOG.0000000000004206.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.