Effect of a technology-based collaborative care model on persistent hypertension and preventive careattendance among postpartum people with hypertensive disorders of pregnancy - 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. Because barriers such as childcare or transportation issues reduce adherence to in-person BP checks, remote self-measured blood pressure (SMBP) programs have been shown to improve adherence to recommended guidelines. However, to date, SMBP programs have not been shown to reduce severe maternal mortality or mortality or differences in clinical outcomes in the first six weeks postpartum, much less the first year after childbirth. 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 improve 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 on a population level for people with chronic conditions. RI-SPHERES will be compared to the current standard for postpartum HDP management at Women and Infant’s Hospital (WIH), a SMBP program that has managed >2000 people over the past 24 months. 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 1536 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 differences in health outcomes in subpopulations through multilevel interventions, 2) evaluating SMBP programs; and 3) mitigating HDP’s short- and long-term health consequences of HDP.
