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System factors influencing the postpartum transition to primary care for cardiovascular disease risk management among women with hypertensive disorders in pregnancy

Award Number: R01HL164489
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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System factors influencing the postpartum transition to primary care for cardiovascular disease risk management among women with hypertensive disorders in pregnancy - PROJECT SUMMARY Cardiovascular disease (CVD) is the leading cause of death among women in the United States. Women who experience hypertensive disorders in pregnancy (HDP), including chronic hypertension, gestational hypertension, and pre-eclampsia/eclampsia, face substantially higher future CVD risk. About one in seven women experience HDP by the end of their childbearing years, with higher rates among women of color. Transitioning to primary care postpartum is recommended for all women, but has particular urgency for women with HDP. Women with HDP have a high risk of adverse outcomes in the immediate postpartum period (e.g. maternal morbidity and mortality), one to three years postpartum (e.g., hypertension, metabolic syndrome onset), and long-term (e.g. ischemic heart disease, heart failure, stroke). The limited existing research on postpartum primary care utilization shows that up to 80% of women who experienced HDP do not receive primary care in the year following birth. Primary care is an appropriate setting for short and long-term CVD risk management, including identification and treatment of hypertension and hyperlipidemia. However, little is known about the primary care provided for postpartum women with HDP and whether it responds to their heightened CVD risk. Despite low rates of postpartum transition to primary care for women with HDP, little is known about how systems factors impact this transition and primary care CVD risk assessment and management in the postpartum year. Using an explanatory-sequential mixed methods design, we examine the postpartum transition to primary care for CVD risk management for women with HDP in Massachusetts and nationally. These aims address NHLBI’s strategic objective to “investigate factors that account for differences in health among populations,” which includes managing cardiometabolic risk to improve health trajectories in sex-specific populations. The specific aims are 1) To determine the role of systems factors in the transition to preventive primary care for women with HDP in the postpartum year; 2) To characterize and examine clinician and organizational factors influencing cardiometabolic risk assessment and management in primary care in the postpartum year; and 3) To identify organizational and contextual factors shaping the postpartum transition to primary care and CVD risk management in primary care. With input from a multi-stakeholder advisory board, we will integrate results across aims to develop practice and policy recommendations to improve care quality for women with HDP to reduce future CVD risk. Results from this study will contribute to an improved understanding of systems factors associated with successful transition to postpartum primary care for women at high CVD risk, and help to identify interventions, healthcare quality metrics, and policy levers to improve clinical practice.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $469,315 )
2025	2025	BAYSTATE MEDICAL CENTER, INC.	759 CHESTNUT STREET	SPRINGFIELD	MA	01199	HAMPDEN	USA	Cardiovascular Diseases Research	000	4	3/28/2025	NON-COMPETING CONTINUATION	$469,315
														Subtotal = $469,315

Issue Date FY: 2024 ( Subtotal = $722,727 )
2024	2024	BAYSTATE MEDICAL CENTER, INC.	759 CHESTNUT STREET	SPRINGFIELD	MA	01199	HAMPDEN	USA	Cardiovascular Diseases Research	001	3	6/21/2024	NON-COMPETING CONTINUATION	$39,666
2024	2024	BAYSTATE MEDICAL CENTER, INC.	759 CHESTNUT STREET	SPRINGFIELD	MA	01199	HAMPDEN	USA	Arthritis, Musculoskeletal and Skin Diseases Research	002	3	7/29/2024	SUPPLEMENT FOR EXPANSION	$236,799
2024	2024	BAYSTATE MEDICAL CENTER, INC.	759 CHESTNUT STREET	SPRINGFIELD	MA	01199	HAMPDEN	USA	Cardiovascular Diseases Research	000	3	4/3/2024	NON-COMPETING CONTINUATION	$446,262
														Subtotal = $722,727

Issue Date FY: 2023 ( Subtotal = $665,637 )
2023	2023	BAYSTATE MEDICAL CENTER, INC.	759 CHESTNUT STREET	SPRINGFIELD	MA	01199	HAMPDEN	USA	Cardiovascular Diseases Research	002	2	8/3/2023	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$665,637
2023	2023	UNIVERSITY OF MASSACHUSETTS	COMMONWEALTH AVE	AMHERST	MA	01003	HAMPSHIRE	USA	Cardiovascular Diseases Research	001	1	8/2/2023	NEW	-$665,639
2023	2023	UNIVERSITY OF MASSACHUSETTS	COMMONWEALTH AVE	AMHERST	MA	01003	HAMPSHIRE	USA	Cardiovascular Diseases Research	000	1	4/4/2023	NEW	$665,639
														Subtotal = $665,637

Grand Total All Awards = $1,857,679

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System factors influencing the postpartum transition to primary care for cardiovascular disease risk management among women with hypertensive disorders in pregnancy

Award Number: R01HL164489

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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