Document Type
Dissertation
Degree
Doctor of Nursing Practice
Major
Nursing
Date of Defense
7-16-2025
Graduate Advisor
Charity Galgani, DNP, APRN, WHNP-BC
Committee
Christina Castellano, PhD, RN
Jayne Mangi, DNP, APRN, WHNP-BC
Abstract
Problem: Postpartum appointment attendance remains a critical aspect of maternal healthcare, particularly among women in an inner-city, urban outpatient setting. Despite prior efforts to improve scheduling efficiency and telehealth adoption, no-show rates for the first weeks postpartum visit, both in-person and virtual visits, remain consistently high, limiting access to essential postpartum care. This study aimed to increase the postpartum compliance (comp) rate by 5% through the implementation of telehealth scheduling improvements.
Methods: A quality improvement (QI) project was conducted at an urban, outpatient Women’s Health Clinic (WHC) serving a diverse inner-city population. The intervention focused on refining scheduling processes by integrating the .PPVISIT communication tool, which facilitated coordination between inpatient discharge providers and outpatient WHC schedulers. Additionally, Nurse Practitioners (NPs) were encouraged to schedule postpartum appointments before an induction of labor (IOL) date to improve attendance rates. Data collection included pre- and post-intervention show rates for virtual and in-person visits, with statistical analysis using a Chi-square test to examine relationships between intervention implementation of the communication tool .PPVISIT and appointment type.
Results: Following the intervention period, postpartum appointment compliance rates increased modestly from 54.74% to 59.06%. However, statistical analysis found no significant association between intervention implementation and appointment type, indicating that in-person visits remained the preferred modality. Virtual visit attendance remained unchanged at 50%, with persistent no-show rates among vaginal delivery patients. Also, systemic challenges, including staffing disruptions and communication barriers between inpatient and outpatient teams, limited the overall effectiveness of the intervention.
Implications: While the intervention did not achieve a statistically significant increase in compliance rates, the findings highlight potential areas for future improvement. Strengths of the project included its diverse patient population, high patient volume, and the introduction of communication tools that facilitated more efficient scheduling coordination. Future initiatives should focus on addressing telehealth adoption barriers, optimizing scheduling workflows, and refining outreach strategies to enhance postpartum appointment attendance. Incorporating patient-centered engagement efforts and leveraging qualitative feedback could further improve postpartum care accessibility and adherence.
Recommended Citation
Jungewaelter, Kelli L., "Implementation of Telehealth Optimization to Improve Postpartum Visit Adherence" (2025). Dissertations. 1532.
https://irl.umsl.edu/dissertation/1532