Clinical Trial Summary
The literature unequivocally supports follow-up in the postpartum period post hospital
discharge in hypertensive patients, compared to uncomplicated delivery follow-up
recommendations of 4-6 weeks postpartum, leading to decreased morbidity and mortality,
utilizing at-home blood pressure monitoring and virtual/telemedicine appointments. There is
much evidence that telemedicine visits are equally, if not more effective, result in cost
savings, and are generally preferred by patients, specifically when there is a risk of
exposure for the patient and newborn, an appropriate factor to consider amidst the global
Covid-19 pandemic. Maternal health and well-being have substantial links with cultural and
racial factors. Black women are three times as likely to have morbid outcomes related to
gestational complications, specifically hypertensive disorders of pregnancy. Minority
populations have historically displayed inferior access to care due to concerns related to
transportation, healthcare insurance, or provider accessibility and distrust, resulting in
diminished compliance with follow-up and negative health sequelae.
Telemedicine follow-up within 10 days of delivery (48-72 hours after discharge) reduces
readmission rates, increase access to- and compliance with care, and improve patient safety
satisfaction, thus establishing feasibility. Home vital sign monitoring gives an increased
volume of data points for providers to utilize in titrating antihypertensive medications to
optimize blood pressure control, ultimately decreasing stroke and cardiovascular risk.
Existing research lacks comprehension regarding specific cardiological impacts of labile
postpartum blood pressures, however researchers inferentially hypothesize that poor blood
pressure management in the postpartum period can have devastating long-term cardiological
consequences.
This QI project will demonstrate standardized programming for patients with hypertensive
disorders of pregnancy (HDP), which may potentially lead to increased compliance,
satisfaction, and accessibility, resulting in improved long-term cardiovascular health in
vulnerable populations. The American heart Association (AHA) and ACOG have established that
HDP are associated with long-term cardiovascular disease, however obstetricians lack guidance
on effective, evidence-based research for standardization of care, leading to subsequently
disjointed medical management with much room for error in transitioning from obstetrician to
internist or cardiologist. Thus, implementing and establishing feasibility of remote
monitoring and follow-up while applying standardized algorithms and protocols for
antihypertensive medication titration and management may provide support in addressing and
eradicating these gaps. As such, this pilot project has massive prospective future
applicability and benefit for a highly vulnerable population.
This QI project out of CSMC will create a formal remote patient follow-up and monitoring
program utilizing the platform Vytrack as its' primary technology. Vytrack has the capability
to sync with the EHR utilized by CSMC (C-S Link, an iteration of Epic), however this feature
will not be utilized in establishing feasibility during this pilot project, due to cost
prohibitions. Vytrack will provide participants with Bluetooth technology that automatically
uploads in real-time and access to an application on participant's personal smartphone
devices. Providers may choose to create emergency alerts within desired parameters for
participant's uploaded vital signs via a provider portal.
30 participants will be manually enrolled with Vytrack after eligibility is confirmed by the
primary investigator. Participants will receive standard education on how to properly use
Vytrack technology and prompted to check their vital signs twice daily (morning and night) or
more per primary obstetrician preference until the end of their enrollment period (ten days
postpartum), while additionally maintaining their primary obstetrician's standard care.
Additionally, participants will be scheduled for a virtual medical appointment at 48-72 hours
post hospital discharge for vital sign evaluation and optimization with a provider, employing
an algorithm to titrate antihypertensive therapy as needed. The initial usage of
antihypertensive therapy will be in accordance with the participant's care team as an
inpatient.
The goal of this project is predominantly to establish feasibility of such programming in
this large academic hospital setting through ascertaining retention rates over ten days
postpartum as well as participant satisfaction, with a target of at least 90% retention and
compliance rate and at least 80% satisfaction over traditional methods. Satisfaction will be
analyzed through post-participation surveys, displaying Likert-scale style questions.
Secondarily, through improved patient engagement in postpartum care and accessibility to
standardized management, this QI project anticipates at least a 20% reduction in postpartum
readmissions for hypertensive emergencies.
