Preeclampsia is a disorder of pregnancy characterized by high blood pressure and high levels of protein in the urine. Hypertension is the leading cause of maternal morbidity and mortality in the U.S. and, at the beginning of this project, was the leading cause of seven-day readmissions for obstetrics patients at the Hospital of the University of Pennsylvania (HUP).
While risk factors were known, no strategy existed for effective, reliable blood pressure surveillance for at-risk patients. At the start of this project, blood pressure monitoring required patients to attend a one-time, in-person appointment. However, professional association guidelines published by the American College of Obstetricians and Gynecologists (ACOG) in 2014 recommended two points of monitoring: 72 hours and seven to ten days post-discharge.
As part of a project led by the Division of Maternal Fetal Medicine, we developed and tested a text-based intervention for hypertension. We enrolled patients in a remote blood pressure monitoring program during the first seven days post-discharge from the Labor and Delivery floor at HUP.
Over the course of seven iterative pilots, over 30 patients were discharged with digital blood pressure monitors and sent reminders via text message to check their blood pressure twice daily. Once submitted by the patient, blood pressure results were reviewed and responded to by an Ob/Gyn physician.
The intervention showed major improvement over standard care and produced strong early evidence for a text-based strategy that enables effective, reliable blood pressure surveillance for at-risk patients.
There were no seven-day readmissions among enrolled patients, compared to a 5% readmission rate among women monitored through in-person visits. The percent of patients to report at least one blood pressure reading in the first week post-discharge jumped from 15% pre-intervention to 84% among all enrolled patients.
The percent of patients to report blood pressure readings on five of seven days in the first week post-discharge jumped from 0% pre-intervention to 69% among all enrolled patients.
After the conclusion of the pilot, the team received funding from the Penn PCORI Grant and Penn Presbyterian Harrison Fund to conduct a randomized, controlled trial of the intervention. The team was recognized for their leadership with a first prize award in the American Heart Association's Philadelphia Heart Science Forum Innovation Challenge, Digital Health Category, and first place in the Council on Patient Safety in Women’s Health National Improvement Challenge on Hypertension in Pregnancy.
December 2017: Heart Safe Motherhood continues to make postpartum remote blood pressure monitoring easy so that providers can catch rising blood pressure earlier and keep patients safe at home.
In our randomized, controlled trial, we saw our ability to meet ACOG guidelines on postpartum blood monitoring leap from 0% to 82% compared to in-person office visits and seven-day readmissions from hypertension drop from 3% to 0%.
Heart Safe Motherhood is now the standard of care for obstetrics patients at HUP with plans to scale to other Penn Medicine locations in 2018.
The team is also partnering with health systems, payers, and vendors to evaluate the ability to scale the program for national impact.