(1170) Linking patients to primary and subspecialty care through a high-risk fourth trimester clinic

Objective: To describe the primary care (PC) and subspecialty needs of high-risk patients seen at a specialized postpartum clinic within a racially and ethnically diverse urban health system and to determine associations between having a preexisting primary care provider (PCP) and clinic referral indication and postpartum care utilization.

Study Design: An observational cohort of high-risk patients was followed for 12 months (6/2022 to 6/2023) at a dedicated postpartum clinic that provides care-coordination. High-risk indications for clinic referral included a chronic medical condition and/or adverse delivery or immediate postpartum event. All patients were asked about their PC and subspecialty needs. A care coordinator helped schedule PCP and subspecialty follow-ups if indicated. Summary statistics described patients’ PC and subspecialty needs. Bivariate analyses comparing postpartum attendance characteristics and clinic referral indication by identification of a PCP at entry to postpartum care were performed using chi-square and Mann-Whitney U tests.

Results: Out of N=143 patients seen at the Fourth Trimester clinic, 78.3% (n=112) were publicly insured and 95.1% (n=136) identified as non-white. 52.5% (n=75) identified a PCP at entry to postpartum care. Among the 47.6% (n=68) without a PCP, 73.1% (n=49) received care coordination to schedule a PCP visit and, of these, 63.2% (n=31) attended their appointment. 51.0% (n=73) of patients needed to see at least one subspecialist. 16.7% (n=24) received care coordination to schedule a subspecialty visit; 58.3% (n=14) attended their appointment. No statistically significant difference was found in clinic referral indication, number of postpartum visits attended, or attendance within 21 days postpartum between those with and without a preexisting PCP.

Conclusion: Almost half of high-risk patients seen for care at our specialized Fourth Trimester clinic did not identify a PCP at entry to postpartum care. Care coordination linked the majority of these patients to a PCP after delivery, demonstrating its importance in the transition from postpartum to PC.