Research Question:

In postpartum patients, does implementing a “Fourth Trimester” care model with shared decision-making and risk-stratified follow-up, compared with standard care, reduce hospital readmissions and improve maternal health outcomes within the first year postpartum?

Significance:

New Jersey’s maternal mortality crisis, which ranked the state 47th nationally with a rate of 26.0 deaths per 100,000 (2018-2022)¹,²,³, demanded an evidence-based response. With over 60% of preventable maternal deaths occurring postpartum⁴, our health network, serving 15% of the state’s births, developed an equitable evidence-based Fourth Trimester care model. Our transformative model ensures every mother receives vital postpartum follow-up resources, regardless of background, blending rigorous data with real-world impact to advance knowledge and create meaningful change.

Data/Methods:

We conducted descriptive, comparative, and trend analyses using t-tests, Wilcoxon, and chi-square tests. Outcomes were assessed by year, by data type, and by distribution.

Our fourth-trimester model screens for social needs and offers risk-based follow-up at 3, 5, or 7 days for high-, intermediate-, or low-risk patients, with personalized support. To enhance our approach, we introduced a new initiative, a visual cue for rapid escalation of care for hypertensive disorders, complemented by teach-back education on warning signs to empower patients.

Results:

The fourth-trimester model significantly reduced postpartum readmissions by 85.7% (from 7% in 2022 to 1% in 2025) and achieved zero maternal deaths within the network during the study period. Concurrently, New Jersey’s statewide maternal health ranking improved, from 47th to 25th. This scalable collaborative approach addressed urgent postpartum needs and rebuilt trust between patients and providers, demonstrating a successful model for translating population health science into meaningful, system-level change.