Postpartum Remote Blood Pressure Monitoring Program: Study of Reducing Severe Maternal Morbidity among Black and Latina Women by Incorporating Patient Experiences and Systems Science

项目总结 严重的孕产妇发病率(SMM)每年影响美国65,000多名妇女， 包括在分娩期间和产后可能发生的危及生命的情况。种族和民族 SMM在分娩时的差异是有据可查的，越来越多的证据表明这些差异持续存在 进入产后期。非西班牙裔黑人和西班牙裔女性的产后病率是后者的2到3倍 高血压并发症与白人女性的比较及相应的差异 心血管相关事件，占产后SMM的一半，是最引人注目的。这些健康 差异是由个人、人际和结构性因素组成的复杂系统驱动的。2020年，波士顿 新英格兰最大的安全网医院医疗中心实施远程血压监测 高血压高危女性被送回家接受云连接血液的计划 产后按压套住，每日监测6周。该项目将评估新的 实施计划降低非西班牙裔产后一年内SMM的发病率 黑人和西班牙裔女性。我们假设，这种削减将通过较少的 计划外医疗访问，包括分流/紧急护理以及重新入院；以及 改善自我管理。我们的提案将专门针对高风险、非西班牙裔黑人和西班牙裔 妇女开展以下具体目标(1)检查远程血压监测的影响 保健利用方案，包括6周和12个月的计划外和计划内就诊 (2)收集远程血压监测和自测血压的可接受性的定性数据。 50名患者(25名黑人和25名西班牙裔)和10名提供者的高血压管理 结构化访谈；以及(3)开发产后SMM的复杂系统科学模型，解释 个人、人际和结构层面的因素内部和之间的关系，由经验提供信息 波士顿医疗中心约38,000次分娩的数据(2004-2019年)，并使用该模型模拟 远程血压监测对产后SMM的影响这样做的最终目的是 研究的目的是利用现有的数据资源，获得定性的患者反馈，并利用先进的 评估现有血压监测程序的可接受性和影响的计算方法 在减少有色人种高危妇女产后SMM方面。这一方法将提供关键的证据 关于远程产后血压监测计划的可行性，以此作为减少 SMM方面的差距。

PROJECT SUMMARY Severe maternal morbidity (SMM) affects more than 65,000 women in the United States annually and includes life-threatening conditions that can occur during delivery and the postpartum period. Racial and ethnic disparities in SMM at delivery are well-documented and accruing evidence shows that these disparities persist into the postpartum period. Non-Hispanic Black and Hispanic women have 2 to 3 times the rate of postpartum hypertensive complications compared to White women and accordingly disparities with regards to cardiovascular-related events, which account for half of all postpartum SMM, are most striking. These health disparities are driven by a complex system of individual, interpersonal, and structural factors. In 2020, Boston Medical Center, the largest safety-net hospital in New England, implemented a remote blood pressure monitoring program in which women who are at elevated risk for hypertension are sent home with a cloud-connected blood pressure cuff postpartum for six weeks of daily monitoring. This project will evaluate whether the newly implemented program reduces the incidence of postpartum SMM in the year after delivery among non-Hispanic Black and Hispanic women. We hypothesize that this reduction will operate through mechanisms of fewer unscheduled healthcare visits, including both triage/emergency care as well as hospital readmissions, and improved self-management. Our proposal will focus specifically on high-risk, non-Hispanic Black and Hispanic women to conduct the following specific aims (1) examine the impact of the remote blood pressure monitoring program on healthcare utilization, including unscheduled and scheduled visits through 6 weeks and 12 months postpartum; (2) collect qualitative data on the acceptability of the remote blood pressure monitoring and self- management of hypertension among 50 patients (25 Black and 25 Hispanic) and 10 providers through semi- structured interviews; and (3) develop a complex systems science model of postpartum SMM, accounting for relationships within and between factors at the individual, interpersonal and structural level informed by empirical data on approximately 38,000 deliveries at Boston Medical Center (2004-2019), and use that model to simulate the impact of the remote blood pressure monitoring program on postpartum SMM. The ultimate goal of this research is to harness existing data resources, elicit qualitative patient feedback, and utilize advanced computational methods to assess the acceptability and impact of an existing blood pressure monitoring program in reducing postpartum SMM among high-risk women of color. This approach will provide critical evidence regarding the feasibility of a remote postpartum blood pressure monitoring program as a means to reducing disparities in SMM.