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

项目摘要 严重孕产妇发病率（SMM）每年影响美国65，000多名妇女， 包括在分娩和产后期间可能发生的危及生命的状况。种族和族裔 在交付时，SMM的差异是有据可查的，越来越多的证据表明，这些差异仍然存在 进入产后期非西班牙裔黑人和西班牙裔妇女产后死亡率是非西班牙裔妇女的2至3倍。 与白色女性相比， 占所有产后SMM一半的心血管相关事件是最引人注目的。这些健康 造成差异的是一个由个人、人际和结构因素组成的复杂系统。2020年，波士顿 医疗中心，最大的安全网医院在新英格兰，实施了远程血压监测 一项计划，在该计划中，高血压风险较高的妇女被送回家， 压力袖带产后6周每日监测。该项目将评估新的 实施的计划降低了非西班牙裔妇女产后一年内SMM的发生率 黑人和西班牙裔女性我们假设，这种减少将通过更少的机制运作， 计划外的医疗访视，包括分诊/急诊以及再次入院，以及 改善自我管理。我们的建议将特别关注高风险，非西班牙裔黑人和西班牙裔 妇女进行以下具体目标（1）检查远程血压监测的影响 医疗保健利用计划，包括6周和12个月内的计划外和计划内访视 产后;（2）收集关于远程血压监测和自我监测的可接受性的定性数据， 在50名患者（25名黑人和25名西班牙裔）和10名供应商中通过半 结构化访谈;（3）开发产后SMM的复杂系统科学模型， 在个人，人际和结构层面的因素内部和之间的关系，通过经验 波士顿医疗中心（2004-2019年）约38，000次分娩的数据，并使用该模型模拟 远程血压监测计划对产后SMM的影响。这个项目的最终目标 研究是利用现有的数据资源，引出定性的病人反馈，并利用先进的 评估现有血压监测计划的可接受性和影响的计算方法 减少有色人种高危妇女产后SMM的风险。这种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， SMM中的差异。

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.