UPMC Uses Telehealth to Help New Moms Dealing With Hypertension

A remote patient monitoring program launched two years ago at UPMC is helping care providers identify and treat new mothers dealing with hypertension.

The telehealth program, which sends new moms home with an mHealth-enabled blood pressure cuff and urges them to monitor their blood pressure daily and text-message that data to care providers, has helped the health system reduce rehospitalizations and other negative clinical outcomes, while improving collaboration between providers and patients at home.

“We know they’re listening to us,” Beth Quinn, MSN, program director for women’s health services at UPMC Magee Women’s Hospital in Pittsburgh, says of the women enrolled in the program. “They’re listening to us, and they’re even quoting to us what they’d been told by their nurses. That tells us we’re making an impact.”

Launched in 2018 by UPMC and the Magee-Women’s Research Institute, the RPM program aims to address a significant factor in the nation’s high maternal mortality rate. According to Hyagriv Simhan, MD, a professor of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh and executive vice chairman of obstetrical services at UPMC-Magee, it targets a particular pain point in post-discharge care.

“Hypertension … puts women at risk for readmission and significant complications, including (a higher chance of developing) chronic diseases later on, yet today’s fragmented healthcare system is not well designed to educate and monitor at home,” he says. “That’s the gap that we sought to close with this program.”

UPMC also sought to improve the link between new moms and their care providers, giving them more and better opportunities to connect with each other during those crucial few weeks after childbirth. According to the American College of Obstetricians and Gynecologists, only two-thirds of new mothers identified as having a hypertensive disorder follow up with doctors at least once in the six weeks after leaving the hospital.

To analyze the impact of a connected health platform that reaches these patients at home, Simhan and his colleagues recruited roughly 500 new mothers (UPMC sees about 9,000 births a year) to use the new technology in 2018 and 2019.

The patients were told to take their blood pressure once a day for five days and text that data back to the hospital. If those readings were normal, the standard one-week follow-up appointment was cancelled - that happened 43 percent of the time. For the rest, care providers worked with the patients to continue remote monitoring.

According to the study, authored by Simhan and his colleagues, UMPC saw post-partum appointments surge to 90 percent, well above the national average of 60 percent. In addition, some 40 percent of new mothers with hypertension issues not only kept in touch with the hospital, but made appointments with their primary care provider to continue care management.

In addition, 83 percent of those mothers continued with UPMC’s RPM program three weeks after leaving the hospital, and almost three-quarters continued at least a month. And in terms of patient engagement, 94 percent said they were satisfied with the experience and 82 percent said they were more comfortable knowing that a nurse was checking on their health each day.

Quinn says the program has been adjusted to address concerns. Whereas patients were initially sent home with the blood pressure cuff and some education on how to use it, hospital staff now sit down with the new mom for at least 30 minutes, going over how to use the technology and answering any questions that pop up.

“The program really needed to be fed and watered and pruned along the way,” says Simhan. “We realized we needed to put more work into the human component, to make sure that everyone was comfortable.”

“We did a lot of data collection,” adds Quinn, who adds that UPMC and its telemedicine partner, Vivify Health, expect to create dashboards out of that process.

Quinn and Simhan see the short-term goal of the program in improved care management for new mothers, especially those with hypertension. Over the long term, they note, this type of service can morph into a chronic care platform that helps care providers and these patients identify the risk of heart disease and other negative outcomes.

Simhan says the program also gives patients a sense of control over the care, as well as sense of responsibility for monitoring what could be a significant health concern.

“They’re now acknowledging that there is an issue that needs to be managed,” he says. “They see the significance of the problem and the need for this type of program.”

Quinn sees the program continuing to expand and scale up, not only to new hospitals – two rural sites, UPMC-Horizon and UPMC Northwest, will soon offer the service – but to new populations that require home-based monitoring. And Simhan wants to add AI tools to the platform.

“It’s an innovative way to render clinical care,” he says. “We should be holding this up as an example.”