Remote BP Monitoring in the PP Period

Study Overview
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Brief Summary
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The purpose of this study is to trial remote patient monitoring (RPM) in the postpartum hypertensive population in a randomized control design, with an aim to increase the number of blood pressure measurements taken during the fragile and under-monitored postpartum period and to thereby improve postpartum blood pressure control and reduce severe morbidity and mortality. The investigators plan to compare the number of blood pressures recorded in the first 10 days postpartum between patients who have been enrolled in an RPM trial to those who are being treated with the usual care.

Detailed Description
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Many women develop high blood pressure as a complication of pregnancy. This high blood pressure can often take many weeks to resolve, and for some women it never resolves completely. If untreated, high blood pressure of pregnancy can lead to serious consequences, such as seizure or stroke. Unfortunately, because most women are sent home from the hospital just 2-3 days after having a baby, the best way of monitoring blood pressure at home is still unknown. Most women are given a prescription for a blood pressure cuff to use at home and an appointment to see their doctor at about one week after delivery to review their blood pressures, but many women have trouble checking their blood pressures, sometimes because they have a new baby at home and sometimes for other reasons like transportation or difficult social situations. Using a Bluetooth blood pressure monitoring system might help women have better blood pressure monitoring after they are discharged from the hospital after delivery, and therefore help to prevent some of the complications that can happen because of high blood pressure related to pregnancy.

Official Title
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A Remote Postpartum (PP) Blood Pressure Surveillance and Reminder System for Hypertensive Disorders of Pregnancy: A Randomized Clinical Trial

Conditions
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Hypertensive Disorder of Pregnancy

Intervention / Treatment
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* Device: Remote Patient Monitoring


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Postpartum women Previous diagnosis of chronic hypertension, or antepartum diagnosis of hypertensive disorder of pregnancy (defined as documented blood pressure of ≥140 systolic or ≥90 diastolic on at least 2 occasions at least 4 hours apart) At least 18 years of age English or Spanish speakers Exclusion Criteria: Non-English or Spanish speakers Women who are not planning on obtaining their postpartum follow up at CUIMC Women who are physically unable to hold or use the tablet Women who do not have a working phone Provider unwilling or unable to set up escalation pathway Women who reside outside of New York State Hypertension diagnosed postpartum

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Randomized Control Trial with 2 arms
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Usual Care<br>Usual care group patients will be assigned to the usual care given to patients with hypertensive disorders of pregnancy at Columbia University Irving Medical Center (CUIMC). This involves a prescription for a blood pressure cuff if they do not already have one, with which they will be asked to measure their blood pressure twice per day. They will be asked to keep a log of their blood pressure measurements and to bring that log to their next provider visit. | |
| Experimental: Remote Patient Monitoring<br>Remote Patient Monitoring patients will use a Bluetooth-enabled blood pressure cuff, which will transmit blood pressure measurements via Bluetooth from the monitor to a tablet, which is able to be accessed by nurses staffing a remote clinical care center. Patients will also be prompted to answer surveys assessing symptoms of preeclampsia. The nurses will review measurements and survey results, which will be flagged in order of urgency. The measurements uploaded into the remote monitoring system will also be reviewed at the patient's next provider visit. | Device: Remote Patient Monitoring<br>* Bluetooth-enabled blood pressure cuff to assess whether this technology helps providers collect more data regarding their patients' blood pressures in the postpartum period.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Blood Pressure (BP) Surveillance Adherence | Percentage of recommended twice-daily blood pressures reported between hospital discharge and first outpatient blood pressure assessment | Up to 14 days from delivery hospitalization discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Elevated Blood Pressure Percentage | Percentage of recorded blood pressure values at first outpatient blood pressure assessment that are elevated (>140 systolic or >90 diastolic) | Up to 14 days from delivery hospitalization discharge | 
| Number of Participants With Outpatient BP Assessment Within 14 Days | Number of participants who had a documented outpatient BP assessment within 14 days of hospital discharge | Up to 14 days from delivery hospitalization discharge | 
| Incidence of BP Elevations | Incidence of elevated blood pressure at outpatient blood pressure assessment | Up to 14 days from delivery hospitalization discharge | 
| Number of Participants With Outpatient PP Assessment | Number of participants who had an outpatient postpartum (PP) assessment | Up to 8 weeks from delivery | 
| Incidence of BP Elevations | Incidence of elevated blood pressure (BP) at the postpartum visit | Up to 8 weeks from delivery | 
| Time to Medication Initiation | Time to initiation of antihypertensive medications (in patients who were not on medications at time of discharge) | Up to 8 weeks from delivery | 
| Number of Participants Initiated on Antihypertensive Therapy After Hospital Discharge | Number of participants discharged from delivery hospitalization without antihypertensive therapy, who were subsequently started on antihypertensive therapy | Up to 8 weeks from delivery | 
| Number of Participants Readmitted | Number of participants who were readmitted after delivery hospitalization discharge | Up to 8 weeks from delivery | 
| Number of Participants With ED Visit | Number of participants who had an Emergency Department (ED) visit after delivery hospitalization discharge | Up to 8 weeks from delivery | 
| Number of Participants Who Developed Preeclampsia-associated Complications | Number of patients who experienced preeclampsia-related morbidity (eg: stroke, seizure, posterior reversible encephalopathy syndrome (PRES) , pulmonary edema, liver function abnormality, reversible cerebral vasoconstriction syndrome (RCVS) , renal insufficiency, thrombocytopenia) after delivery hospitalization discharge. | Up to 8 weeks from delivery | 
| Number of Participants Referred to Primary Care for Continued Blood Pressure Management | Number of participants who require a referral to primary care physicians for continued blood pressure management after being discharged from obstetric care at the postpartum visit | Up to 8 weeks from delivery | 
| Score on the Modified Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ) | The modified TSUQ is an 18-item survey that will be used to measure patient satisfaction with remote blood pressure monitoring. Individuals score each of the items based on their satisfaction, with 1=strongly disagree to 5=strongly agree. The responses would then be used to calculate a mean score on the 5-point scale, with 5 indicating the most satisfaction. | Up to 8 weeks from delivery | 
| Change in Score on the Philips Program Survey | The Philips program start survey is a 4 question survey to gauge how patients relate to their care and their doctors prior to initiation of their blood pressure monitoring program. Individuals score each of the items based on the perception of their care, with 5 being best and 1 being worst. The responses would then be used to calculate a mean score on the 5-point scale, with 5 indicating the most satisfaction, and compared between the 2 groups. The Philips program end survey is a 6 question survey to gauge how patients related to their care and their doctors after the completion of their blood pressure monitoring program. Individuals score each of the items based on the perception of their care, with 5 being best and 1 being worst. The responses would then be used to calculate a mean score on the 5-point scale, with 5 indicating the most satisfaction, and compared between the 2 groups. | Up to 8 weeks from delivery | 
| Communications | Elevated blood pressures that led to communication with an obstetric provider | Up to 14 days post delivery hospitalization discharge | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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hypertensive disorders of pregnancy, preeclampsia, gestational hypertension, HELLP