Comprehensive Postpartum Management for Women with Hypertensive Disorders of Pregnancy

妊娠期高血压疾病妇女的产后综合管理

• 批准号: 10604847
• 负责人: Sarah Scheiderich Osmundson
• 金额: $ 26.59万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-21 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10604847
• 关键词: Accounting; Address; Affect; American College of Obstetricians and Gynecologists; Birth; Black race; Blood Pressure; Blood Pressure Monitors; Cardiovascular system; Caring; Cessation of life; Chronic; Clinical; Communities; Consent; Discipline of obstetrics; Documentation; Eclampsia; Electronic Health Record; Future; Guidelines; HELLP Syndrome; Home Blood Pressure Monitoring; Hypertension; Individual; Intervention; Kidney Failure; Legal patent; Maternal Health; Maternal Mortality; Maternal-fetal medicine; Medicaid; Medical; Modeling; Morbidity - disease rate; Multicenter Trials; Nurse Midwives; Nurses; Outcome; Outcome Measure; Outpatients; Participant; Patient Care; Patient Outcomes Assessments; Patients; Physicians; Population; Postpartum Hypertension; Postpartum Period; Postpartum Programs; Pre-Eclampsia; Pregnancy; Primary Health Care; Process; Pulmonary Edema; Race; Randomized; Recommendation; Reporting; Risk; Social Workers; Specialist; Stress; Stroke; Surveys; System; Telemedicine; Tennessee; Time; Ursidae Family; Visit; Woman; Work; base; black patient; blood pressure control; care fragmentation; community engaged research; community engagement; disparity reduction; experience; follow-up; health care service organization; hypertension control; improved; medical vulnerability; multidisciplinary; patient engagement; peer; perceived discrimination; postpartum care; pregnancy disorder; pregnancy hypertension; pregnancy related death; primary outcome; programs; racial disparity; randomized trial; satisfaction; secondary outcome; severe maternal morbidity; trial comparing

SUMMARY Hypertensive disorders of pregnancy (HDP) - chronic hypertension, gestational hypertension, preeclampsia, HELLP, and eclampsia - account for a substantial portion of severe maternal morbidity and mortality in the U.S. and occur 2.5 times more frequently among Black compared to non-Black patients. The weeks after birth are crucial for maternal health, especially considering that half of all pregnancy-related deaths occur postpartum. The American College of Obstetricians and Gynecologists recently redefined postpartum care to encompass 12 months after birth and stressed the importance of connecting postpartum patients to primary care clinicians to manage chronic medical conditions. This handoff is critical as 50% of patients with HDP develop chronic hypertension, and patients with HDP have twice the risk of later cardiovascular-related death. In line with this recommendation, Tennessee recently expanded Medicaid coverage to 12 months postpartum. Given that most obstetric clinicians currently do not provide comprehensive primary care, we urgently need models for bridging gaps in care after pregnancy especially for medically vulnerable patients. While interventions such as telemedicine and peer navigation demonstrate promise to improve patient engagement in care and reduce postpartum racial disparities, no randomized trials address system-level initiatives to improve postpartum care for patients with HDP. We propose to build a comprehensive management program for postpartum patients with HDP who are at risk of severe maternal morbidity and mortality. Using a community-engaged approach, we will tailor this program to Black patients who represent a disproportionate share of those affected by postpartum HDP. This program emphasizes three key components: 1) self-monitoring of blood pressures, 2) blood pressure management navigation, and 3) facilitated transition to primary care clinicians for hypertension management. Our multidisciplinary team, including maternal-fetal medicine specialists, certified nurse midwives, program navigators, and social workers will accomplish our specific aims to: 1) conduct rigorous patient engagement that identifies barriers and facilitators to postpartum hypertension care especially among Black patients 2) conduct rigorous clinician engagement that uncovers barriers and facilitators to postpartum hypertension management, and 3) perform a pilot randomized trial comparing usual postpartum care to our comprehensive HDP management program. We hypothesize that our intervention will increase patient engagement with blood pressure monitoring, identify more patients with severe-range blood pressures, and reduce disparities in outcomes between Black and non-Black patients. Our work directly advances integrated models of care using community-engaged research among populations who bear a disproportionate burden of severe maternal morbidity and mortality. The results will produce stakeholder-informed outcomes and key parameter estimates for conducting a robust multicenter trial.

概括 妊娠期高血压疾病 (HDP) - 慢性高血压、妊娠期高血压、先兆子痫、 HELLP 和子痫 - 占美国严重孕产妇发病率和死亡率的很大一部分。 与非黑人患者相比，黑人患者的发生频率高 2.5 倍。出生后几周是 对于孕产妇健康至关重要，特别是考虑到一半与妊娠相关的死亡发生在产后。 美国妇产科医师学会最近重新定义了产后护理，以涵盖 出生后 12 个月，强调将产后患者与初级保健临床医生联系起来的重要性 管理慢性疾病。这种交接至关重要，因为 50% 的 HDP 患者会发展成慢性 高血压和 HDP 患者后期心血管相关死亡的风险是其两倍。符合这个 根据建议，田纳西州最近将医疗补助覆盖范围扩大到产后 12 个月。鉴于大多数 产科临床医生目前不提供全面的初级保健，我们迫切需要桥接模型 怀孕后护理方面的差距，特别是对于医疗上脆弱的患者。虽然干预措施如 远程医疗和同伴导航有望提高患者护理参与度并减少 产后种族差异，没有随机试验解决改善产后护理的系统级举措 对于 HDP 患者。我们建议为产后患者建立一个全面的管理方案 患有 HDP 的人面临严重孕产妇发病和死亡的风险。使用社区参与的方法， 我们将为黑人患者量身定制该计划，这些患者在受该病影响的患者中所占比例不成比例 产后 HDP。该计划强调三个关键组成部分：1）自我监测血压，2） 血压管理导航，3) 促进高血压初级保健临床医生的过渡 管理。我们的多学科团队，包括母胎医学专家、认证护士 助产士、项目引导员和社会工作者将实现我们的具体目标：1) 进行严格的 患者参与，确定产后高血压护理的障碍和促进因素，尤其是在产后高血压护理中 黑人患者 2) 进行严格的临床医生参与，发现产后的障碍和促进因素 高血压管理，3) 进行一项试点随机试验，将常规产后护理与我们的产后护理进行比较 全面的 HDP 管理计划。我们假设我们的干预将增加患者 参与血压监测，识别更多患有严重血压范围的患者，以及 减少黑人和非黑人患者之间的结果差异。我们的工作直接推进集成化 利用社区参与的研究为承受不成比例的负担的人群提供护理模式 孕产妇发病率和死亡率严重。结果将产生利益相关者知情的结果和关键 用于进行稳健的多中心试验的参数估计。