879 Utilization of postpartum home blood pressure monitoring across different obstetrical care settings

Abstract

To assess feasibility of implementing an evidence-based home blood pressure (BP) monitoring system for postpartum women and evaluate utilization across different obstetrical care settings. This quality improvement initiative enrolled postpartum women with any hypertensive disorder of pregnancy or chronic hypertension. To enroll they also had to be English speaking and have access to a text messaging. We utilized University of Pennsylvania’s Heart Safe Motherhood text-based platform, in which, women received twice daily automated reminders/feedback to transmitted BP values over a 14-day period following hospital discharge. Our primary outcomes were program reach (defined as the proportion of eligible women willing to participate) and individual level implementation (defined as adherence with texting at least 1 BP within 72 hours of discharge and responding to at least 50% of BP reminders). Completion was defined as participation throughout the 14 days without unenrollment. We aimed to enroll 80% of eligible women with 90% and 80% adherence rates respectively. We further evaluated the enrollment and adherence rates by practice group serving both privately and publicly insured patients. In the first 3 months following implementation (April 1, 2020 – June 30, 2020), 278 women were eligible for enrollment. Of these women, 247 enrolled (88.8%) with a 92.7% completion rate. There was an overall adherence rate of 92.1% within 72 hours of enrollment and 84.7% adherence with at least 50% of BP reminders. All of which met our stated aims. Figure 1 describes enrollment and adherence rates broken down by practice group. Adherence throughout the 14-day period tended to be below our goal of 80% in practices with more publicly insured patient populations (Figure 1). Our study demonstrates that successful implementation of home BP monitoring is feasible across differing obstetrical care settings. The inability to meet our 80% 14-day adherence goal in groups with higher public insurance rates may represent unique barriers to care that these patients face.