Pregnancy-related hypertension affects up to 10% of 6.2 million pregnancies each year in the United States and may lead to preeclampsia, a disease unique to pregnancy consisting of elevated blood pressures and risk of progression to stroke, seizure, and end-organ damage. It is the leading cause of seven-day obstetrical readmissions and is responsible for 20% of the 700 maternal deaths in the United States each year.
In 2014, the American College of Obstetricians and Gynecologists (ACOG) issued new guidelines on hypertension in pregnancy urging providers to measure two blood pressures postpartum for women with pregnancy-related hypertension, once at 72 hours and another seven to ten days after delivery. Most providers have patients return to the office for blood pressure checks or have visiting nurses obtain a reading at the patient’s home. Most new moms find it hard to come to the office for a blood pressure check in this critical time period.
The Approach / Study Overview
Heart Safe Motherhood is a novel approach to care delivery that leverages connected health technology and a new role for Obstetrical providers to transform the quality, safety, experience, and cost of care during women’s transition from hospital admission after delivery to home. The goal of Heart Safe Motherhood is to drive better maternal outcomes, improve the care experience, and reduce the total cost of care for women with pregnancy-related and chronic hypertension in the immediate postpartum period. Through text-based remote monitoring, Heart Safe motherhood reduces the burden of preeclampsia.
Way to Health use
Heart Safe Motherhood uses Way to Health to automate the program and produce a provider-facing, population-management dashboard. On discharge, Way to Health starts patients on a blood pressure monitoring protocol automatically, sending patients twice daily reminders to send their blood pressure for 10 days. Way to Health also automates responses to patients and alerts to providers based on our provider-developed algorithm.
Way to Health allows us to increase efficiency exponentially through automation and exception handling, such that one provider can manage the blood pressures of an entire hospital’s enrolled deliveries in just a few hours a week.
Key Way To Health features used:
- Two way texting: SMS for reminders and also to receive BP data
- Rules Engine: Implementation of a clinician designed algorithm to detect abnormalities for follow-up
- Alerts: To providers or other care providers in case of high BP
- EHR Integrations: Two way integration to Epic to auto-enroll patients into the program and push data back into the patient flowsheet.
Results / Outcomes
In 2017, we completed a randomized, controlled trial comparing Heart Safe Motherhood to office visits. We found an increase in our ability to meet guidelines in up to 80% of our patients using text messaging. Readmissions dropped to zero percent among monitored women. In addition, women enrolled in the program were more likely to attend their postpartum visit. Our clinical trial results were published in BMJ Quality and Safety.
Based on these results, we scaled the program at the Hospital of the University of Pennsylvania, where among women monitored by the Heart Safe Motherhood Program,
- Adherence to ACOG guidelines increased from 0% pre-implementation to 80% and
- 7-day readmissions for hypertension decreased from 5% pre-implementation to 1%