PITTSBURGH, Sept. 10, 2019 - America has the highest maternal mortality rate in the developed world, and it's getting worse. Since cardiovascular disease is the primary cause, researchers at the University of Pittsburgh School of Medicine and the Magee-Womens Research Institute (MWRI) created a blood pressure home-monitoring program to rapidly detect concerning trends in postpartum women before their situation becomes critical.
To address the rising maternal mortality rate, the American College of Obstetricians and Gynecologists (ACOG) recently upped their recommended frequency for postpartum checkups, starting within three weeks of birth. But right now, only about 66% of new mothers diagnosed with a hypertensive disorder are making it back to the clinic for what is usually a single follow-up appointment around six weeks postpartum. That figure jumped to 88% when the researchers gave women a blood pressure cuff and periodically prompted them to text their readings to a nurse, according to a study published today in the journal Obstetrics & Gynecology.
"We're meeting women where they are instead of saying they have to come to the hospital for all these blood pressure checks when they have a new baby," said lead author Alisse Hauspurg, M.D., assistant professor of obstetrics, gynecology and reproductive sciences at Pitt. "I think this is supported by recent ACOG recommendations and is an opportunity to improve care for high-risk women."
Between February 2018 and January 2019, the researchers enrolled 499 patients with preeclampsia, eclampsia or chronic, gestational or postpartum hypertension. Each was discharged from the postpartum unit with an automatic blood pressure cuff and instructions on how to take their own readings at home.
A computerized system integrated with the participants' electronic health records prompts them to take their own blood pressure and heart rate readings once a day for five days. If their readings are normal, their one-week follow-up appointment is automatically cancelled, which was the case for 43% of the women. Patients taking blood pressure medications start to taper down, and patients who aren't taking any medications decrease the frequency of their readings.
Abnormal readings lead to an increase in monitoring frequency and automatically notify the patient's health care provider. Dangerously high readings trigger a trip to the emergency room.
Overall, 83% of participants continued the program beyond three weeks postpartum and 74% continued for four weeks or more.
According to the researchers, this study demonstrates feasibility and high levels of engagement in the program, which should be straightforward to expand.
"One of the big advantages here is scalability," said senior author Hyagriv Simhan, M.D., professor of obstetrics, gynecology and reproductive sciences at Pitt, and executive vice chair of obstetrical services UPMC Magee-Womens Hospital. "Connecting women in their 'fourth trimester' to online care allows us to engage a larger number of patients over a larger geography with the infrastructure and workforce we already have."
Of the 250 women who filled out a post-program survey, 94% said they were satisfied with the experience and 82% said they were more comfortable knowing that a nurse was checking on their health every day.
One goal of the program is to bridge care from obstetricians to ongoing -- albeit less intensive -- cardiovascular monitoring. So far, 63% of the study participants have either scheduled an appointment or established care with a primary care provider.
"Home blood pressure monitoring gives patients ownership. They're texting their numbers in," Hauspurg said. "Hypertensive disorders of pregnancy impact women for the rest of their lives, so to have ownership over their own health is really important. We're empowering them to know their numbers."
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Additional authors on the study include Laura Lemon, Pharm.D., Ph.D., Beth Quinn, R.N., Anna Binstock, M.D., Jacob Larkin, M.D., Richard Beigi, M.D., and Andrew Watson, M.D., all of UPMC Magee-Womens Hospital and Pitt.
The study was supported by institutional funds and Building Interdisciplinary Research Careers in Women's Health (BIRCWH) scholar funds from the National Institutes of Health (grant number K12HD043441).
The remote monitoring platform integral to the program was supplied by Vivify Health. UPMC was an investor in Vivify at the time of the study.
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About UPMC
A $20 billion health care provider and insurer, Pittsburgh-based UPMC is inventing new models of patient-centered, cost-effective, accountable care. The largest nongovernmental employer in Pennsylvania, UPMC integrates 87,000 employees, 40 hospitals, 700 doctors' offices and outpatient sites, and a 3.5 million-member Insurance Services Division, the largest medical insurer in western Pennsylvania. In the most recent fiscal year, UPMC contributed $1.2 billion in benefits to its communities, including more care to the region's most vulnerable citizens than any other health care institution, and paid $587 million in federal, state and local taxes. Working in close collaboration with the University of Pittsburgh Schools of the Health Sciences, UPMC shares its clinical, managerial and technological skills worldwide through its innovation and commercialization arm, UPMC Enterprises, and through UPMC International. U.S. News & World Report consistently ranks UPMC Presbyterian Shadyside on its annual Honor Roll of America's Best Hospitals. For more information, go to UPMC.com.
About Magee-Womens Research Institute
Magee-Womens Research Institute (MWRI) is the largest research institute in the U.S. devoted exclusively to health conditions affecting women and infants. The Institute is leading discoveries and advancing knowledge in the field of reproductive biology and medicine, translating this knowledge into improved health, wellness and disease prevention for women, engaging our community in women's health, and training the present and future generations of women's health researchers.
About the University of Pittsburgh School of Medicine
As one of the nation's leading academic centers for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates, Pitt has ranked among the top 10 recipients of funding from the National Institutes of Health since 1998. In rankings recently released by the National Science Foundation, Pitt ranked fifth among all American universities in total federal science and engineering research and development support.
Likewise, the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs, for which it is recognized as an innovative leader, and to training highly skilled, compassionate clinicians and creative scientists well-equipped to engage in world-class research. The School of Medicine is the academic partner of UPMC, which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the region's economy. For more information about the School of Medicine, see http://www.medschool.pitt.edu.
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Journal
Obstetrics and Gynecology