Remote Patient Monitoring for Postpartum Hypertensive Disorders of Pregnancy [ID: 1378058

Abstract

INTRODUCTION: Hypertensive disorders of pregnancy (HDP) account for 2.5–4.6% of readmissions within 6 weeks postpartum (PP); 60% occur in the first 7 days. A standardized approach to HDP management can improve outcomes through optimized PP blood pressure (BP) management. Remote patient monitoring (RPM) has established safety, outcomes, financial benefit, and increased compliance. The primary outcome of this study was to determine the feasibility of a standardized RPM program for PP patients with HDP. METHODS: Participants (n=30) received a phone application and BP monitor that automatically uploaded data to a nurse practitioner (NP)-monitored dashboard. Participants were asked to record a single BP twice daily (6 am–11 am and 6 pm–11 pm) until 10 days PP. Telehealth visits with an NP occurred at 48 hours postdischarge. Feasibility was measured using a one-sided t test of the proportion of participants with satisfaction (via validated Likert-style post-participation surveys) and adherence of 80% or higher (recorded BPs/expected BPs). Secondary outcomes included readmissions, elevated BPs (mild, 140–159/90–109 mm Hg; severe, ≥160/110 mm Hg), and antihypertensive medication up-titration. RESULTS: One hundred percent of participants completed the program. Overall adherence rate was 91%, and overall satisfaction rate was 92%. Of 450 recorded BP measurements, 88 (19.6%) were mild and 2 (0.4%) were severe, with 0 hospital readmissions. Medication up-titration occurred seven times in six participants (20%). We demonstrated feasibility with a proportion of 0.767 participants (P=.0027; CI: 0.577, 0.885). CONCLUSION: A standardized RPM program for PP HDP utilizing early telemedicine visits with an NP successfully demonstrated feasibility in a pilot sample of PP patients. Compliance with PP follow-up recommendations was high. Future work to improve systems innovation for BP optimization in PP patients is needed.