PRENATAL & POSTPARTUM CARE (PPC)

Eligible population: Delivered a live birth on or between 8 de octubre of the year prior to the measurement year and 7 de octubre of the measurement year. Members in hospice are excluded from the eligible population.

Timeliness of prenatal care – A prenatal visit during the first trimester, on or before the enrollment start date or within 42 days of enrollment, depending on the date of enrollment in the organization and the gaps in enrollment during the pregnancy.

Postpartum care – A postpartum visit on or between seven and 84 days after delivery.

Denominator date: Date of delivery as listed in administrative data.

PRENATAL CARE

• A prenatal visit in the first trimester, on or before the enrollment start date or within 42 days of enrollment, depending on the date of enrollment in the organization and gaps in enrollment during the pregnancy. Do not count visits that occur on the date of delivery.
• Prenatal care visit to an OB/GYN or other prenatal care practitioner, or PCP. For visits to a PCP, a diagnosis of pregnancy must be present. Documentation in the medical record must include a note indicating the date when the prenatal care visit occurred, and evidence of one of the following:
  • Documentation indicating the woman is pregnant or references to pregnancy; for example:
    • Documentation in a standardized prenatal flow sheet, or
    • Documentation of LMP, EDD, or gestational age, or
    • A positive pregnancy test result, or
    • Documentation of gravida and para, or
    • Documentation of a complete obstetrical history, or
    • Documentation of prenatal risk assessment and counseling/education.
• A basic physical obstetrical examination that includes auscultation for fetal heart tone, or pelvic exam with obstetric observations, or measurement of fundus height (a standardized prenatal flow sheet may be used).
• Evidence that a prenatal care procedure was performed, such as:
  • Screening test in the form of an obstetric panel (must include all of the following: hematocrit, differential WBC count, platelet count, hepatitis B surface antigen, rubella antibody, syphilis test, RBC antibody screen, Rh and ABO blood typing), or
  • TORCH* antibody panel alone, or
  • A rubella antibody test/titer with an Rh incompatibility (ABO/Rh) blood typing, or
  • Ultrasound of a pregnant uterus.

POSTPARTUM CARE

• A postpartum visit to an OB/GYN or other prenatal care provider or PCP on or between seven and 84 days after delivery.
• Documentation in the medical record must include a note indicating the date when a postpartum visit occurred and one of the following:
  • Pelvic exam
  • Evaluation of weight, BP, breasts, and abdomen
    • Notation of “breastfeeding" is acceptable for the “evaluation of breasts" component.
  • Notation of postpartum care, including, but not limited to:
    • Notation of “postpartum care," “PP care," “PP check," or “6-week check"
    • A preprinted “Postpartum Care" form in which information was documented during the visit
  • Perineal or cesarean incision/wound check
  • Screening for depression, anxiety, tobacco use, substance use disorder, or preexisting mental health disorders
  • Glucose screening for women with gestational diabetes
  • Documentation of any of the following topics:
    • Infant care or breastfeeding
    • Resumption of intercourse, birth spacing, or family planning
    • Sleep/fatigue
    • Resumption of physical activity and attainment of healthy weight

*TORCH Panel/TORCH SCREEN

The TORCH PANEL/TORCH SCREEN test is used to help diagnose infections that could harm the fetus during pregnancy. TORCH is an acronym of the five infections covered in the screening:

• Toxoplasmosis. This infection is caused by a parasite commonly picked up from cat stools. Babies can develop congenital toxoplasmosis, which if untreated, can cause blindness, deafness, seizures, and intellectual disability.
• Other, including syphilis. Syphilis is a sexually transmitted infection that a mother can pass on to a fetus during pregnancy. Syphilis can cause a baby to be stillborn, and can also cause premature labor, birth defects, low birth weight, and deafness.
• Rubella. Rubella, also called German measles, is a viral infection that can easily be passed from person to person through sneezing or coughing. Rubella is less common today because a vaccine protects against it, but pregnant women with rubella can pass the virus to a fetus. Rubella can cause miscarriage or stillbirth, as well as problems with growth of the fetus.
• Cytomegalovirus (CMV). CMV is a type of herpes virus and is the most common congenital infection in babies. Mothers can get CMV by sexual contact or contact with bodily fluids like saliva from a person who has CMV. CMV can cause long-term problems in infants, including problems with vision, hearing, and mental development.
• Herpes simplex virus (HSV). Pregnant women can get HSV through sexual contact with an infected person and can pass the infection along to the developing fetus during delivery. HSV in babies can cause low birth weight, miscarriage, and preterm birth. It can also cause sores that affect the skin, eyes, and mouth, as well as brain and organ damage.

These infections can cause serious problems during pregnancy, so it's important to find them early in pregnancy so that they can be treated. Women often get the TORCH screening test at their first prenatal visit. If and when a woman has the TORCH screening is the doctor’s decision.

This test may also be done on newborn babies to diagnose any possible infections. The TORCH PANEL requires a blood sample either by a finger stick or by a blood draw.

BCBSRI is committed to making it easier for your practice to be successful in all areas of quality improvement. Together, we can achieve our shared goal of improving health outcomes by identifying and addressing open care gaps.

Hints for HEDIS® (and more) is a reference tool developed to explore various quality topics, including:

• Definitions, specifications, and exclusions of the many quality measures;
• Billing codes used to report gap closure;
• Collection and reporting methodologies; and
• Tips and best practices to maximize gap closure.

Our Quality Concierge Team (QCT) is also available to answer questions, provide updates, assist in the interpretation of monthly gap in care reports, and provide overall HEDIS support to you and your practice. Reach our QCT nurses at QualityHEDIS@bcbsri.org or (401) 459-1005.