Virtual and in-person postpartum visit attendance, emergency department use, and hospital readmissions before, during, and after the COVID-19 pandemic: a retrospective cohort study in a diverse urban Bronx population

Objective To evaluate postpartum in person and telehealth follow-up attendance before, during, and after the COVID-19 pandemic in a large, urban, racially diverse obstetric population. Methods We conducted a retrospective cohort study of 13,874 patients who received prenatal care and delivered at Montefiore Medical Center between June 2018 - May 2022. Four periods were defined based on key COVID-19 milestones: pre-COVID (before 3/11/2020, pandemic declaration), early COVID (3/11/2020–6/11/2020, elective procedures cancelled), late COVID (6/12/2020–6/15/2021, elective procedures resumed, no widespread vaccination), and post-COVID (after 6/15/2021, vaccines widely available). The primary outcome was postpartum visit (PPV) attendance within 12 weeks of delivery. Chi-square tests compared PPV attendance across periods. Logistic regression adjusted for demographics, prenatal care, comorbidities, delivery outcomes, and NICU admission. Secondary outcomes included emergency room (ER) visits and readmissions within 12 weeks. Results There were 6,989 (50.4%) deliveries pre-COVID, 944 (6.8%) during early COVID, 3,273 (23.6%) during late COVID and 2,668 (19.2%) post-COVID. Compared to pre-COVID PPV attendance of 46.2%, PPV rates increased significantly during early (73.5%), late (63.7%) and post-COVID (59.8%), p < 0.01). After adjustment, compared to pre-COVID, patients who delivered during early COVID had a 3.5x higher odds of attending a PPV (aOR 3.50, 95% CI 2.97–4.11), 1.98x higher odds during late COVID (aOR 1.98, 95% CI 1.80–2.17) and 1.6x higher odds post-COVID (aOR 1.61, 95% CI 1.45–1.78), all p < 0.01. Compared to pre-COVID, ER visits were less likely during early (aOR 0.61, 95% CI 0.49–0.76, p < 0.01) and late COVID (aOR 0.87, 95% CI 0.77–0.99, p = 0.03), and hospital readmission were more likely post-COVID (OR 1.35, 95% CI 1.07–1.69, p = 0.010). Conclusion PPV attendance increased during the COVID-19 pandemic and remained elevated post-pandemic. This pattern may reflect forced changes in care delivery, such as expanded telehealth use, that may have helped reduce longstanding barriers to follow-up. Sustained implementation of flexible care models may help preserve these gains.