Clinical Outcomes Associated With a Remote Postpartum Hypertension Monitoring Program

Abstract

OBJECTIVE: To evaluate differences in health care utilization and guideline adherence for postpartum individuals with hypertensive disorders of pregnancy (HDP) who are engaged in a remote monitoring program, compared with usual care. METHODS: This was a retrospective cohort study of postpartum individuals with HDP who delivered between March 2019 and June 2023 at a single institution. The primary exposure was enrollment in a remote hypertension management program that relies on patient home blood pressure (BP) measurement and centralized nursing team management. Patients enrolled in the program were compared with those receiving usual care. Outcomes included postpartum readmission, office visit within 6 weeks postpartum, BP measurement within 10 days, and initiation of antihypertensive medication. We performed multivariable logistic and conditional regression in a propensity score matched cohort. Propensity scores, generated by modeling likelihood of program participation, were assessed for even distribution by group, ensuring standardized bias of less than 10% after matching. RESULTS: Overall, 12,038 eligible individuals (6,556 participants, 5,482 in the control group) were included. Program participants were more likely to be White, commercially insured, be diagnosed with preeclampsia, and have higher prenatal and inpatient postpartum BPs. Differences in baseline factors were well-balanced after implementation of propensity score. Program enrollment was associated with lower 6-week postpartum readmission rates, demonstrating 1 fewer readmission for every 100 individuals in the program (propensity score–matched adjusted risk difference [aRD] −1.5, 95% CI, −2.6 to −0.46; adjusted risk ratio [aRR] 0.78, 95% CI, 0.65–0.93). For every 100 individuals enrolled in the program, 85 more had a BP recorded within 10 days (propensity score–matched aRD 85.4, 95% CI, 84.3–86.6), and six more had a 6-week postpartum office visit (propensity score–matched aRD 5.7, 95% CI, 3.9–7.6). Program enrollment was also associated with increased initiation of an antihypertensive medication postpartum (propensity score–matched aRR 4.44, 95% CI, 3.88–5.07). CONCLUSION: Participation in a postpartum remote BP monitoring program was associated with fewer postpartum hospital readmissions, higher attendance at postpartum visits, improved guideline adherence, and higher rates of antihypertensive use.