How it works · 12 weeks
The twelve weeks, week by week.
- birth 0 enrolled; a named contact confirmed
- day 3 recovery · one mood item · one barrier item
- day 7 check-in · early-visit reminder if on her plan
- day 14 check-in · the screening step
- day 21 a human contact confirmed, not assumed
- week 6 visit preparation · screen repeated · referral followed
- week 9 unresolved-issue sweep · summary drafted for review
- week 12 comprehensive visit · transition with owners
Seven short check-ins, a named person, and a next step that is verified, not assumed. Each check-in is designed to take under ninety seconds. Each answer that needs a person gets one, with a name, a clock, and a logged outcome.
In development. This page describes the program as it is being built for the pilot; there are no outcomes to cite yet.
Week by week
What happens at each mark, and what the practice records.
Day 0 is the day of birth, including a stillbirth. The twelve weeks are an evaluation window, not a claim that risk ends there; the program closes with a transition that names an owner for anything still open.
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Birth · day 0
Enrolled, with a named contact confirmed
Enrollment happens late in pregnancy or before discharge. Before delivery she sees an acknowledgment, her preferences, the name of her contact at the practice and the correct after-hours instruction, and nothing else: no check-ins, no reminders, no pregnancy content. If she is enrolled late, the check-ins she missed are marked not applicable, never counted against her.
recorded: eligibility status for every eligible patient · named contact confirmed by the coordinator -
Day 3
Recovery, one mood item, one barrier item
The opening check-in asks how recovery is going, one question about mood, and one about anything practical in the way: a ride, a phone, time off work. A barrier answer creates a follow-through item with an owner at the practice; it does not disappear into a message thread.
recorded: check-in complete · partial · skipped · unopened · not applicable -
Day 7
Check-in, and an early-visit reminder if it is on her plan
If her plan includes an early visit, for a blood-pressure check or an incision check, the reminder is here, in the practice’s own words. She can ask for a callback. The callback is recorded when it happens, with the minutes it took, not when it was requested.
recorded: callback occurred · 12 min -
Day 14
Check-in, then the screening step
After the check-in, a mental-health screening instrument is offered as its own clearly labelled step. The practice chooses the instrument (the EPDS or PHQ-9, with the GAD-7 optional) and sets its thresholds; the practice’s named clinical owner approves them. The framing states which item is always shared. A positive screen reaches a clinician within the practice’s same-business-day target. The model never reads or interprets a score.
recorded: time from positive screen to clinician assessment -
Day 21
A human contact, confirmed rather than assumed
ACOG asks for initial contact within three weeks of birth. NestWell counts that contact when a person at the practice has logged one, whether a call, a visit or an in-person enrollment, and never because a message was delivered or read. If she has gone quiet, one unreached item is created with an owner, outreach is logged, and no further reminders are sent.
ACOG marker initial contact by 3 weeks recorded: initial contact by day 21 · set by a logged human contact, or visibly unmet -
Week 6
Visit preparation, the screen repeated, the referral followed
Her care plan explains what the comprehensive visit is for and what to bring. The questions she saved are grouped for the visit, with her own words alongside. The screening step repeats if the practice configures it, and a one-item usefulness question is asked. A referral made earlier is followed to the appointment, not to the link.
recorded: visit completed · referral: appointment kept · usefulness at week 6 -
Week 9
Unresolved-issue sweep; a summary drafted for review
Everything still open is listed. A draft of what changed and what remains is assembled from the logged events for her clinician to review and sign. Nothing enters the chart without a person’s signature; the draft is a starting point for a clinician, not a conclusion.
recorded: summary reviewed · an owner for each open item -
Week 12
Transition, with an owner for every open item
The comprehensive postpartum visit ACOG recommends by twelve weeks. She sees a plain-language transition page: her primary care contact, whether a mental-health connection is confirmed, what is open, and whom to call. The practice sees the same list with a named owner and a next contact date per item. “No destination identified” is recorded as a finding rather than hidden.
ACOG marker comprehensive visit by 12 weeks recorded: comprehensive visit completed · destination named, or “no destination identified”
Two markers from ACOG
- ACOG · initial contact within 3 weeks NestWell: a logged human contact by day 21. Delivered messages do not count.
- ACOG · comprehensive visit by 12 weeks NestWell: the visit recorded as completed, and a transition reviewed with an owner for each open item.
ACOG frames postpartum care as an ongoing process rather than a single visit. The program is built to these two markers and reports against them, counting every eligible patient.
Every check-in, every time
- At most five single-tap items; designed to take under ninety seconds; one hand
- The emergency instruction and “I need help now” sit above the questions, as locked text
- Skip is always available; “Not now” reschedules once; a pause she sets is never treated as going quiet
- No streaks, badges, scores, or “you missed a check-in”
- It closes with a process statement, what the practice will do and by when, and never a comment on her answers
What a patient gets
What she gets, and how the practice knows it happened.
Each item either moves her toward the next step in her care or records that it happened. The check-in itself is demonstrated on the home page.
- A brief check-in
- Day 3, 7, 14 and 21, then week 6, 9 and 12. A few questions about recovery, mood, symptoms and practical barriers, with an easy way to skip or to ask for help.recorded as: complete · partial · skipped · unopened · not applicable
- A care plan she can understand
- Clinician-approved explanations of her existing plan, what to bring to the visit, and the questions she has saved to ask, with her own words kept alongside.recorded as: approved content version shown
- A named person she can reach
- A care coordinator at her practice, by name, the practice’s after-hours instruction, and human review whenever an answer needs it. Coverage hours are shown to her.recorded as: owner · coverage hours · acknowledged in minutes
- Verified follow-through
- A referral counts when the appointment was kept, not when a link was sent. A callback counts when it happened, with the minutes logged. Missed targets stay visible.recorded as: referral: appointment kept · callback logged 12 min
- A concise clinician summary
- At week 9 and week 12, a draft of what changed and what is still open, for her clinician to review and sign, with an owner for every open item.recorded as: reviewed · signed · an owner per open item
The accountability loop
Check-in, owner, verified step, clinician summary. Then the next check-in.
A check-in is not finished when it is sent. It is finished when a named person has acknowledged it, the next step has happened, and her clinician has a summary. Every node below carries the kind of label the practice actually sees.
What “verified” means
A referral counts when the appointment was kept. Everything before that is a message.
NestWell records a step when it happened, not when something was sent. The record comes from a person’s log or a partner’s confirmation, and a missed target stays visibly unmet.
Counts as follow-through
- A referral, when the appointment was kept, confirmed by the referral partner or logged by the coordinator
- A callback, when it happened, with the minutes it took
- Initial contact by day 21, when a person at the practice logged a call, a visit or an in-person enrollment
- A postpartum visit, when the practice marked it completed
- A summary, when a clinician reviewed and signed it
Does not count
- A referral link sent, or a referral scheduled and not yet kept
- A callback requested, or attempted without reaching her
- A message delivered, opened, or read
- A reminder that went out
- A summary drafted and not yet signed
| Event | Recorded as | Set by | Follow-through |
|---|---|---|---|
| Referral sent, day 15 | referral: link sent | system | not yet |
| Partner books the appointment, day 22 | referral: scheduled · day 22 | referral partner | not yet |
| She attends, day 31 | referral: appointment kept · day 31 | referral partner confirmation | verified |
| Callback requested, day 7 | callback: requested | patient | not yet |
| Coordinator reaches her, day 8 | callback logged 12 min | coordinator’s log | verified |
| Two check-ins unopened; reached by phone on day 27 | initial contact: day 27 · day-21 marker unmet | coordinator’s log | contact verified · target missed, kept visible |
Why missed targets stay visible
A contact logged on day 27 is a real contact, and it counts as one. The day-21 marker still shows as unmet, on purpose. The pilot report counts escalations acknowledged inside target and escalations missed, with every eligible patient in the denominator. A number that cannot go down is not a measurement.
Where AI sits
Where the model sits in the week.
The model is a writing aid inside a program that people run. AI explains approved material and drafts summaries for a clinician to review. It has no say in what is urgent, what a screen means, or what a patient should be told about her own answers.
- day 3 → week 12Explains clinician-approved care-plan material in plain words, and in her language once that language’s safety-critical content is approved.
- week 6Groups the questions she saved so her visit covers them, with her original words kept alongside.
- week 9 · week 12Assembles a draft summary from logged events for a clinician to review and sign. Nothing enters the chart unsigned.
- every callLogged, with the approved source it drew from.
Not at any point in the twelve weeks: deciding what is urgent or ranking her symptoms; diagnosing, screening, or interpreting a screening result; reassuring her or commenting on her answers; holding a therapy-style conversation; changing or softening an emergency instruction, which is locked text; or standing in for her clinician or the named person at her practice.
Default questions, thresholds, escalation rules and patient-facing sentences are reviewed by NestWell’s clinical safety owner, an OB‑GYN, and approved by each practice’s named clinical owner for their own patients. Rules are tested like anything else; a rule is not safe because it is simple.