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Optimizing implementation strategies for guideline-concordant hypertensive disorders of pregnancy care in community clinics

Award Number: R34HL186380
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 08/20/2026
PERIOD OF PERFORMANCE END DATE: 06/30/2029

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Optimizing implementation strategies for guideline-concordant hypertensive disorders of pregnancy care in community clinics - ABSTRACT Background: Hypertensive disorders of pregnancy (HDP), including preeclampsia, occur in 10% of pregnancies in the U.S. and contribute to maternal deaths. Preeclampsia is linked to long-term cardiovascular risk, making prevention a clinical and public health priority. Daily low-dose aspirin (LDA, 81 mg daily) in pregnancy is an effective, evidence-based prevention strategy for high-risk pregnancies. Despite strong evidence and national guidelines, LDA remains under prescribed, especially in resource-constrained settings where HDP risk is highest. Implementation interventions such as clinical decision support, universal screening, and provider education have demonstrated variable success in improving LDA prescribing and use. However, little is known about their relative and combined effectiveness in safety-net clinic environments. In our preliminary study across 11 community clinics, LDA prescribing reached only 64%, with variation by provider type, clinic setting, and risk category (high v. moderate). We propose a future multisite cluster randomized trial using the Multiphase Optimization Strategy (MOST) framework to evaluate the effectiveness of discrete and combined implementation interventions. This NHLBI R34 planning grant supports the preparation phase for that trial. The objective of this proposal is to evaluate the feasibility and acceptability of candidate implementation intervention components designed to improve guideline-concordant care for preventing preeclampsia in safety-net settings. Aims: We will engage 10–15 safety-net clinics across Los Angeles County to assess preeclampsia burden, current practices, and readiness for research collaboration (Aim 1), conduct qualitative interviews with 50 patients and clinicians to assess current HDP prevention efforts and identify key implementation barriers (Aim 2), map candidate implementation intervention components to identified barriers and define the primary optimization criteria for the trial (e.g., feasibility, reach, effectiveness) (Aim 3), and evaluate the feasibility and acceptability of the proposed components among clinicians and patients (Aim 4). We hypothesize that these implementation strategies will be feasible and acceptable in diverse safety-net settings. NIH and


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: 2026 ( Subtotal = $161,500 )
2026	2026	LUNDQUIST INSTITUTE FOR BIOMEDICAL INNOVATION AT HARBOR-UCLA MEDICAL CENTER	1124 W CARSON ST BLDG MRL	TORRANCE	CA	90502	LOS ANGELES	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	1	8/24/2026	NEW	$161,500
														Subtotal = $161,500

Grand Total All Awards = $161,500

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Optimizing implementation strategies for guideline-concordant hypertensive disorders of pregnancy care in community clinics

Award Number: R34HL186380

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

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

PERIOD OF PERFORMANCE START DATE: 08/20/2026

PERIOD OF PERFORMANCE END DATE: 06/30/2029

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