(195) Identifying health systems gaps perceived by postpartum patient navigators at an urban academic medical center

Although the postpartum period is an opportunity to promote long-term health systems usage, a fragmented health care system and high physician workload limit the effectiveness of care teams in promoting longitudinal health. Patient navigation, an intervention that assists individuals in navigating health systems, is a novel innovation in postpartum care. We aimed to describe existing gaps in the postpartum care system as identified through the perceptions of postpartum patient navigators.

Study Design:

In this qualitative study, semi-structured interview guides were used to conduct 5 serial interviews with three postpartum navigators during the first two years of a randomized trial of postpartum patient navigation. In this ongoing trial, navigators support publicly-insured individuals for one year postpartum. Interviews focused on navigators’ relationships with patients, relationships with care teams, and reflections on health care gaps that navigators witnessed. Interviews were transcribed and analyzed using the constant comparative method to identify themes.

Results:

Navigators identified three major themes related to gaps in the postpartum care system: overall health system features, postpartum care challenges, and gaps in the transition to primary care (Table). Health system features that challenged care included fragmentation within the hospital system, fragmentation across institutions, high task burden for patients, and lack of clear communication between patient and care team. Challenges in postpartum care included operational and logistical errors in care and the transient nature of postpartum care. Finally, gaps in the transition to primary care included a lack of communication between care teams and a lack of emphasis on the importance of primary care.

Conclusion:

The perceptions of postpartum patient navigators revealed health system gaps that are substantive barriers to the longitudinal wellbeing of birthing individuals. These results identify areas for improvements in both postpartum care and overall health system structure that can promote lifelong health.