Historically, at the University of Pittsburgh Medical Center Magee-Womens Hospital in Pittsburgh, when a patient has been discharged from the hospital and has had a hypertensive disorder during her pregnancy or postpartum period, it recommended follow-up within a week to the primary OB provider for a blood pressure check.
Patients are sometimes sent home on new medications or continuing to take a medication they were prescribed during the pregnancy related to hypertension diagnosis. These patients are given instructions and education regarding signs and symptoms that would alert them to call their OB or come back to the emergency department.
It has not been a standard of care to ask this population of patients to check their blood pressure regularly and report it back during the weeks following a delivery. Patients experiencing and needing treatment for a hypertensive crisis is the most common reason for readmission to UPMC Magee-Womens Hospital.
These women also are at an increased risk for developing some type of cardiovascular disease later in life because of the development during their pregnancy. Therefore, follow-up with their primary care physician is a goal that the hospital felt needed to be addressed.
PROPOSAL
Expand remote monitoring from chronic disease patient populations – notably COPD and congestive heart failure – to specialized cases such as postpartum hypertension.
"Some of our doctors at UPMC Magee-Women's Hospital have teamed up since February with our technology partner Vivify and the UPMC Enterprises team to use smartphones to monitor women with persistent hypertension postpartum," said Richard Beigi, MD, the hospital's chief medical officer. "Hypertensive disorders affect five to 10 percent of pregnancies and are the number one reason for obstetric readmissions postpartum, according to our docs."
MARKETPLACE
There is a growing market for remote patient monitoring technology. Vendors include A&D Medical, Abbott, Biotronik, Boston Scientific, ClairVista, Qualcomm Life and Spacelabs Healthcare.
MEETING THE CHALLENGE
The University of Pittsburgh Medical Center has been an innovator in the use of remote patient monitoring technology. By reaching patients where they are, using familiar consumer electronics paired with common health peripherals such as blood pressure cuffs and scales, UPMC has dramatically improved patient engagement, reduced emergency department visits, and decreased the number of hospital readmissions for chronically ill patients.
"Through the use of Vivify's digital portal, we are able to send and receive information to our patients in a convenient and familiar manner," Beigi explained. "Patients are invited to participate and must accept the link once it is sent to their phone. They then receive daily text messages with prompts for them to send their blood pressure and pulse and answer a few questions to give us a snapshot of any symptoms they may be experiencing, as well as a view of their overall health."
These responses are checked by the hospital's call center nurses who respond to any alerts or requests from patients. The hospital has created a detailed algorithm that guides the nurses to provide advice, change or discontinue medications, or guide patients to seek emergency care, if needed.
"In our pilot, the women – more than 60 so far – go home after giving birth with a free blood pressure cuff and access to the Vivify portal," Beigi said. "Through that secure system, they send blood pressure readings to nurses at a call center and answer regular text messages about such symptoms as headaches, visual disturbances and shortness of breath—which trigger different levels of alerts based on algorithms created by Magee's maternal fetal medicine experts."
The order for the remote monitoring is generated from the hospital's Cerner EHR and sent to the portal, which sends a text to the patient's phone. Patients can text information to portal, which sends a weekly PDF summary to the healthcare organization's outpatient EHR.
"According to the doctors, this 'bring your own device' method of remote monitoring has allowed them to keep patients at home whenever possible, rather than readmitting them to the hospital or seeing them in the emergency department, a huge benefit to new moms," Beigi said. "This system also more rapidly identifies women who do need to be seen again."
And this period of monitoring, typically six weeks, gives nurses and physicians the chance to educate these patients about the fact that gestational hypertension puts them at much greater risk for cardiovascular disease later in life, so it's especially important to connect them with a primary care physician if they don't have one, he added.
Now that the program is out of the pilot stage, the hospital is continuing to increase enrollment of patients by inviting all providers to use Vivify for their postpartum hypertension patients. It also is looking at remote monitoring use-cases for other high-risk populations in women's health, such as gestational diabetes.
"Remote monitoring through this solution is a useful tool to engage patients through a device they are already using, their smartphone," he said. "It allows them to communicate with our care team at their convenience, and gives us a view of our patients' continual health journey, as well as a way to provide interventions while increasing patient satisfaction."
RESULTS
To date, 57 percent of patients who have been through the remote patient monitoring program have been able to avoid the one-week postpartum visit for a blood pressure check.
"If we have monitored the patient's blood pressures during the first few days after they have been discharged from the hospital and they are within normal limits, there is no need for them to go to the office to have it checked," he explained. "We will continue to watch them for up to six weeks after delivery."
If the patient has other concerns or questions, they are able to return to their OB for that one week follow-up appointment, which is why the number is only 57 percent, he added. Many women have loved being able to avoid the appointment as they are now caring for themselves and a newborn and don't want to leave their homes, he said.
Further, 88 percent of the patients who have gone through the program have come back for the six-week postpartum visit, compared with 30-40 percent nationally, Beigi said.
"We believe these women are engaged in the program and become educated about their disease through this journey," he explained. "We educate and encourage them to continue to seek care due to the increased risks later in life. Early identification and intervention is key for this."
These women stay engaged by returning to their OB visit within 4-6 weeks postpartum before they graduate from the remote monitoring program. The hospital believes many will continue to use the blood pressure cuff and knowledge they have obtained through the program.
ADVICE FOR OTHERS
"We suggest having a team of individuals involved – physicians, nurses, administrators – who really understand operations in order to roll out such a program," Beigi concluded. "There are nuances that come up that require such an understanding in order to work through the processes to make it functional for all involved."
Twitter: @SiwickiHealthIT
Email the writer: [email protected]
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