Effect of a technology-based collaborative care model on persistent hypertension and preventive careattendance among postpartum people with hypertensive disorders of pregnancy - PROJECT SUMMARY/ABSTRACT
Uncontrolled hypertensive disorders of pregnancy (HDP) are a major source of maternal mortality. National
guidelines recommend blood pressure (BP) measurement 3–10 days after discharge and ≥1 preventive care
visit within one year of delivery. Yet, barriers such as childcare or transportation issues reduce adherence to in-
person BP checks, particularly among racial or ethnic minority patients. Programs in which patients self-
measure BP (SMBP) at home show promising results regardless of patient race. However, a recent meta-
analysis concluded current SMBP programs do not reduce maternal mortality or racial disparities in clinical
outcomes, potentially due to their specific limitations: they end within six weeks of birth (though HDP can
persist for months) and have decreased engagement with non-White people or those living in disadvantaged
areas, though these populations are at the highest risk of persistent HTN and its adverse long-term effects.
Thus, there is an urgent need to optimize SMBP programs to target short- and long-term HDP-related
morbidity and to broadly implement these programs to eliminate disparities in HDP-related outcomes. One
such program is Rhode Island (RI)-Statewide Postpartum HypErtension REmote Surveillance (RI-SPHERES),
a technology-based SMBP program that aims to reduce short- and long-term HDP-associated morbidity in RI
using the collaborative care model, a health services intervention that improves health outcomes and reduces
racial disparities on a population level for people with chronic conditions. The proposed research aims to
determine the effectiveness of RI-SPHERES in reducing short- and long-term morbidity associated with HDP
throughout RI. This builds upon our pilot RCT (NCT05595629), in which a standard SMBP program was
compared to a SMBP program that used a Bluetooth-enabled BP cuff that syncs to a smartphone application
(app) to send automated reminders and provide adaptive messaging tailored to distinct BP values and
symptoms. RI-SPHERES will expand this SMBP program to provide app-based patient-informed educational
content on HDP-specific preventive care and bidirectional communication with RI-SPHERES staff for one year
postpartum. Incorporating adaptive and automatic messaging increases RI-SPHERES’ scalability by reducing
clinical staff burden. However, formal analysis of factors that may hinder widespread implementation of RI-
SPHERES is needed. Thus, we will conduct a Hybrid Type I Non-Inferiority Implementation-Effectiveness
Trial among 1,536 patients with HDP that compares a standard SMBP program to RI-SPHERES in terms of
persistent HTN at six weeks postpartum and receipt of preventive care within one year of delivery. We will also
develop an implementation toolkit to facilitate the dissemination of RI-SPHERES. The proposed project is
expected to deliver a mechanism that will fill multiple research gaps for HDP identified by the US
Preventive Services Task Force: 1) addressing health inequities through multilevel interventions, 2)
evaluating SMBP programs; and 3) mitigating HDP’s short- and long-term health consequences of HDP.
