Improving Detection and Management of Postpartum Hypertension

CLINICAL PRIORITY

Clinical leaders at ChristianaCare sought to improve early detection of postpartum hypertension by overcoming low attendance for follow-up office visits. Women with high blood pressure comprised the majority of postpartum readmissions, and there was a notable racial disparity — Black women were readmitted twice as often as Caucasian women.

The team evaluated historical data to understand barriers associated with a 30 percent postpartum office visit rate. Patients reported challenges with the time and resources required to travel to appointments, feelings of exertion associated with the effort, and perceived low benefit from the visit.

APPROACH

ChristianaCare deployed Twistle by Health Catalyst’s remote patient monitoring platform to engage new mothers after discharge. Patients receive a five- to ten-minute overview of the program and a tutorial on remote patient monitoring equipment prior to discharge. Educational messages and assessment forms are automatically sent to each patient’s mobile phone on a prescribed schedule.

Automated replies for responses that are in a normal range offer immediate reassurance. Abnormal responses are escalated to the care team for follow-up, providing an opportunity to titrate medication before the patient requires admission for hypertensive crisis. Open bi-directional texting solidifies engagement, builds trust, and helps the care team identify other concerns, such as lactation issues.

“The program works because of the radical convenience. Our patients love the ability to monitor their blood pressure from the comfort of their own homes, and without having to leave their newborn for a simple blood pressure check. We have had so much positive feedback from patients, doctors, and staff.”

Matthew Hoffman, MD, MPH, FACOG
MARIE E. PINIZZOTTO, M.D., ENDOWED CHAIR OF OBSTETRICS AND GYNECOLOGY AT CHRISTIANACARE

STUDY DESIGN

The team implemented a text-based remote monitoring program modeled after a University of Pennsylvania study¹, which concluded that text-based monitoring is more effective in obtaining blood pressures and meeting current clinical guidelines in the immediate post-discharge period.

A total of 800 patients were enrolled in the ChristianaCare postpartum hypertension monitoring program from February 2019 through May 2020.

“Nighttime automatic notifications have literally saved women’s lives by telling them to report immediately to the hospital for an abnormally high blood pressure. That’s one example of how our mission drives superior women’s health.”

Kate Rudolph, MS
CORPORATE DIRECTOR, MEDICAL GROUP OPERATIONS, WOMEN’S HEALTH

RESULTS

The program has successfully reduced post-partum hypertension-related readmissions and eliminated long-standing racial disparity.

While only 30 percent of patients attended postpartum office visits, the remote monitoring program drove 91 percent of new mothers to submit at least one blood pressure reading (a 203 percent increase), and 70 percent of patients to engage in the full 10-day protocol. ChristianaCare has expanded the duration of the home monitoring program from 10 days to 42 days based upon patient feedback. The additional time supports each patient’s care transition to their primary physician group, or the identification of a primary care provider for those without one. The goal of long-term management of high blood pressure is to reduce the incidence of stroke and death in women.

The remote monitoring program has enrolled an average of 42 mothers per month and reduced readmissions by 55 percent, from an average of 6 each month to 2.7. Among Black women, the readmission rate has dropped from 61 percent to 31 percent, a 49 percent decrease.

REFERENCES

1. Comparing standard office-based follow-up with text-based remote monitoring in the management of postpartum hypertension: a randomized clinical trial. Hirshberg A, et al.BMJ Qual Saf 2018;27:871–877. doi:10.1136/bmjqs-2018-007837