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

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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.