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Heart Safe Motherhood

HSM brochure with blood pressure monitor and cuff

Heart Safe Motherhood

An evidence-based program for postpartum women with hypertension

Project status

Implementation
Scale
Spread

Collaborators

Sindhu Srinivas, MD, MSCE 
Adi Hirshberg, MD 

Innovation leads

Awards

Philadelphia Heart Science Forum Innovation Challenge, American Heart Association, 2016

National Improvement Challenge, Council on Patient Safety in Women's Health Care, 2016

Clinical Innovation Award, Vizient, 2018

National Innovation Challenge, American Hospital Association, 2018

Healthcare Innovator Award, Philadelphia Business Journal, 2018

Edward S. Cooper Award, American Heart Association of Southeastern Pennsylvania, 2024

Funding

Innovation Accelerator Program

Penn Presbyterian Harrison Fund Award

The Preeclampsia Foundation

U.S. Department of Health and Human Services Office on Women’s Health

Opportunity

Preeclampsia is a pregnancy disorder characterized by high blood pressure (hypertension) and increased urine protein levels. Blood pressure in patients with pregnancy-related hypertension can take as long as three months to normalize and is likely to spike in the first ten days after delivery, putting new moms at risk for stroke, seizures, and organ failure.  

In 2013, the American College of Obstetricians and Gynecologists (ACOG) issued guidelines to monitor postpartum blood pressure in this population at two points – once at 72 hours and again seven to 10 days after delivery.  

When ACOG released its recommendations, there was no guidance or best practice model for achieving the new standards. The standard of care at the Hospital of the University of Pennsylvania (HUP) required new moms to return to the office to have their blood pressure taken at the designated touchpoints. Show rates for these visits hovered at less than 50 percent, and hypertension was the leading cause of seven-day readmissions for obstetric patients at HUP in the two years after the recommendations were made.  

Despite numerous efforts to improve show rates – including increasing the availability of appointments and issuing phone and text reminders, practices did not meet ACOG guidelines. 

Intervention 

Heart Safe Motherhood (HSM) is a first-of-its-kind text-based postpartum blood pressure monitoring program. The program, which is administered and managed through Way to Health, enables patients to track their blood pressure from the comfort of their homes and communicate with their care team without visiting a doctor's office.   

Inpatient clinicians on labor and delivery and postpartum service identify and enroll at-risk women in the program based on eligibility criteria, including diagnoses and vital signs. From there, participants are given a digital blood pressure monitor for at-home use. Training on how to use the monitor and education about the program also occurs before discharge.  

Upon discharge, an automated blood pressure monitoring protocol is enacted. Patients are prompted twice daily via text message to take their blood pressure and share it with their care team. Patients with blood pressures within the normal range receive automated, real-time feedback based on a provider-determined algorithm. And when blood pressures are high enough to necessitate intervention, HSM pushes real-time alerts to providers so that, depending on the circumstances, they can reach out for more information, start or adjust medication, or triage patients to in-person care.  

Through automation and exception handling, HSM makes it possible for one provider to manage the blood pressures of an entire hospital's worth of enrolled deliveries in just a few hours a week. 

Impact 

HSM drives better maternal outcomes, improves patient experience, lessens the burden on care teams, and reduces the total cost of care for women with pregnancy-related and chronic hypertension in the immediate postpartum period.   

In 2017, the team completed a randomized controlled trial comparing HSM to the usual care of office-based in-person blood pressure checks. HSM increased the clinic's ability to obtain blood pressure readings, with 92 percent of patients texting their blood pressure compared to 44 percent attending their office visit. And 80 percent of HSM patients met ACOG guidelines. During the study, approximately 15 to 20 percent of women had elevated blood pressure requiring medication initiation or adjustment. There were no readmissions among HSM participants, and women enrolled in the program were more likely to attend their postpartum visit, which is a valuable touchpoint to evaluate physical and mental well-being after delivery and support contraception planning and breastfeeding. At scale, postpartum hypertension readmission rates at HUP dropped from 5 percent before HSM to 1 percent, and hypertension was no longer the leading cause of seven-day obstetrical readmissions.  

A secondary analysis of the trial conducted by the HSM team found that the program eliminated the observed racial disparities in postpartum hypertension blood pressure ascertainment. Before the intervention, non-Black women were significantly more likely to attend an in-person blood pressure check than Black women, yet Black women were at higher risk of poor outcomes. With HSM, the team saw an increase in their ability to capture blood pressure for all patients, regardless of race. 

A further retrospective study based on insurance claims found that HSM participants were less likely to have adverse outcomes, had fewer postnatal ED visits and readmissions, and had more cardiology visits than comparison cohorts. These differences resulted in overall lower medical costs for HSM patients.

HSM is the standard of care for obstetrics patients at HUP, Pennsylvania Hospital, Princeton Medical Center, Chester County Hospital, and Lancaster General Health. The team has also succeeded in spreading the program beyond Penn's walls with implementation at Jefferson Health, Einstein Health, and Washington University in St. Louis. Improved blood pressure ascertainment and reduction in hypertension-related readmissions have been observed at all HSM sites. 

The program will launch at Alameda Health in the spring of 2023, and expansion to additional health systems is under exploration.

Way to Health Specs

Learn more about the platform
Activity monitoring
Arms and randomization
Criteria-based rules
Dashboard view
Device integration
eConsent
EHR integration
Email
Enrollment
Gamification
Incentives
IVR
Multiple languages
Patient portal messaging
Patient-reported outcomes capture
Photo messaging
Remote patient monitoring
Schedule-based rules
Survey administration
Two-way texting
Vitals monitoring

Innovation Methods

A day in the life

One of the best ways to learn more about a problem area is to experience it yourself. Immerse yourself in the physical environment of your user. Do the things they are required to do to gain a firsthand experience of...

A day in the life

We conducted several hours of contextual inquiry in waiting rooms and other clinical spaces frequented by our target population. A common theme across observations was that pregnant patients used their cell phones to communicate via text message. This “aha!” moment led the team to test a text-based intervention to capture blood pressure data. If...

A day in the life

One of the best ways to learn more about a problem area is to experience it yourself. Immerse yourself in the physical environment of your user.

Do the things they are required to do to gain a firsthand experience of the challenges they face. Completing a day in the life exercise will enable you to uncover actionable insights and build empathy for the people you're hoping to help.

A day in the life

We conducted several hours of contextual inquiry in waiting rooms and other clinical spaces frequented by our target population.

A common theme across observations was that pregnant patients used their cell phones to communicate via text message. This “aha!” moment led the team to test a text-based intervention to capture blood pressure data. If pregnant women prefer this modality of communication and postpartum women struggle to come to in-person visits after delivery for various reasons, why not explore if text messaging could help fix the issue?

Fake back end

It is essential to validate feasibility and understand user needs before investing in the design and development of a product or service. A fake back end is a temporary, usually unsustainable, structure that presents...

Fake back end

In the first iteration of HSM, enrolled patients received text messages from a physician acting as an automated bot. Piloting HSM as a fake back end allowed us to test various approaches to patient engagement, including sending personalized messages with the patient and baby's names, pushing reminders at different times, and contacting a support...

Fake back end

It is essential to validate feasibility and understand user needs before investing in the design and development of a product or service.

A fake back end is a temporary, usually unsustainable, structure that presents as a real service to users but is not fully developed on the back end.

Fake back ends can help you answer the questions, "What happens if people use this?" and "Does this move the needle?"

As opposed to fake front ends, fake back ends can produce a real outcome for target users on a small scale. For example, suppose you pretend to be the automated back end of a two-way texting service during a pilot. In that case, the user will receive answers from the service, just ones generated by you instead of automation.

Fake back end

In the first iteration of HSM, enrolled patients received text messages from a physician acting as an automated bot.

Piloting HSM as a fake back end allowed us to test various approaches to patient engagement, including sending personalized messages with the patient and baby's names, pushing reminders at different times, and contacting a support person if the participant did not respond to a morning message.

The most effective approaches were then implemented into the final version of the program. 

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