Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support, Patient Reminder/Invitation, Text Messaging,

Intervention Description: As part of an ongoing quality improvement project, the hospital implemented a remote hypertension monitoring protocol for postpartum women with a diagnosis of chronic hypertension, superimposed preeclampsia, gestational hypertension, preeclampsia, or postpartum hypertension. After identification by an obstetric care provider, women with access to a text messaging-enabled smartphone device are enrolled in the 6-week postpartum program, which is automatically indicated in the electronic medical record. Participants are trained on the use of a blood pressure device (obtained through insurance, patient purchase or hospital provision) by a nurse educator before discharge from the hospital. After discharge, participants are prompted to check their blood pressure 5 days per week and are prescribed an antihypertensive medication from a call center physician if clinically indicated. Women with blood pressures exceeding the goal who are asymptomatic are encouraged to keep their postpartum office visit.

Intervention Results: Among women enrolled in the program, 360 (88%) attended a 6-week postpartum visit, compared with a historical background rate of 60% attendance among all deliveries and 66% attendance among women with a hypertensive disorder of pregnancy in the year before implementation of the program (2017). Compliance with the program was high. Based on the protocol, 177 (43%) women did not require the previously scheduled in-office blood pressure check at 1-week postpartum, the majority (112; 63%) were in the no medication group. Of the 232 women who required a blood pressure check based on the protocol, 198 (85%) women attended the visit. Of the 409 women who have completed the program to date, 340 (83%) continued the program beyond 3 weeks postpartum and 302 (74%) continued the program beyond 4 weeks postpartum. An ongoing goal of the program is to bridge care from obstetricians to primary care physicians; currently 87 (21%) participants have established care with a primary care physician postpartum, with an additional 42% reporting that they have scheduled an appointment with their primary care physician.

Conclusion: In this study, we detail results from an ongoing remote blood pressure monitoring program. We demonstrate high compliance, retention, and patient satisfaction with the program. This is a feasible, scalable remote monitoring program connected to the electronic medical record.

Study Design: Quality improvement project

Setting: University of Pittsburgh medical center

Population of Focus: At risk postpartum women

Sample Size: 499

Age Range: Childbearing age

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support, Patient Reminder/Invitation, Text Messaging,

Intervention Description: The intervention involved a text-based surveillance arm, where women were given an automatic Omron blood pressure cuff and instructed on its use. Patients were enrolled into a texting program platform developed through Way to Health, a web-based platform within the institution, with secure technological infrastructure developed for research. Patients received reminders to text message their blood pressures twice daily for 2 weeks postpartum, and immediate feedback was provided to the patient based on a preprogrammed automated algorithm. The primary investigator was alerted with specified severe range blood pressure values via text message or email, and care was escalated as needed based on the outpatient algorithm used in the office

Intervention Results: The study found that text-based monitoring was more effective in obtaining blood pressures and meeting current clinical guidelines in the immediate post-discharge period in women with pregnancy-related hypertension compared with traditional office-based follow-up.

Conclusion: Text-based monitoring is more effective in obtaining blood pressures and meeting current clinical guidelines in the immediate postdischarge period in women with pregnancy-related hypertension compared with traditional office-based follow-up.

Study Design: Randomized control trial

Setting: Two prenatal practices within a single medical sytem

Population of Focus: Health care providers; postpartum patients with pregnancy-related hypertenion

Sample Size: 206 women with pregnancy-related hypertension

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): Telemedicine Systems (Hospital), Patient Reminder/Invitation,

Intervention Description: The project team created four interventions to address gaps and increase attendance to the 6‐week comprehensive postpartum visit: a schedule log, postpartum telehealth check‐in visit, administering the EPDS within 6 weeks postpartum (during the telehealth check‐in visit), and a team engagement plan. Appointments for a telehealth check‐in visit and a comprehensive postpartum visit were scheduled for each postpartum patient and tracked using the log. Schedulers served as a patient navigator and scheduled both appointments. The nurse practitioners, physician, and midwife performed telehealth check‐in visits 1– 3 weeks postpartum. Providers used a four‐item checklist, created by the team, and placed the text in the summary of their notes. The four items included the EPDS, inquiring about breastfeeding and any issues, discussing the importance of postpartum visits, and asking about needs for community resources.

Intervention Results: The number of people who attended comprehensive postpartum visits increased to 56.8% (up from 27% prior to the intervention). The team performed a χ2 test of independence to determine the statistical significance of outcomes when compared with the baseline data. The outcome shows a statistically significant result, χ2(1, N=228) = 18.05, p=.000022. During the project, the balancing measure, team efficiency, improved as measured by anonymous surveys to team members.

Conclusion: Overall, this project proved to be low cost with high value for patients and the medical department. The initiative improved care by increasing attendance at comprehensive postpartum visits, identify- ing concerns early, detecting postpartum depression or anxiety in six patients, and identifying a surgical site infection during check‐in visits. The team's success would be intriguing to most practices that provide obstetrical care, given that the national postpartum return rate is only 60%. Recommendations for spread and sustainability include dedicated postpartum patient navigators, who would handle the schedule log, continuation of a check‐in visit, electronic EPDS, and ongoing staff education. Further study could show the efficacy of this model in other settings. Given the increased postpartum attendance and early identification of complications, the team successfully improved effective care to postpartum families in North Philadelphia.

Study Design: Quality improvement initiative

Setting: Einstein Medical Center, a large academic hospital in North Philadelphia

Population of Focus: Postpartum patients

Sample Size: 147 patients

Age Range: Childbearing age