Boston Medical Center Sees Success With RPM Program for Postpartum Hypertension

The health system says it's improving engagement and clinical outcomes and reducing barriers to access for new mothers at risk of complications from high blood pressure.

Boston Medical Center is reporting positive results from a remote patient monitoring program for new mothers at risk of postpartum hypertension, and now plans on scaling out the program to address more health concerns.

The program, run in a partnership with digital health company Rimidi, not only helps the health system track and mange care for at-risk patients, but has also reduced barriers to care seen by underserved populations and helped care teams detect serious health concerns early.

“As a safety-net hospital, many of our patients are underinsured and have social determinants that impact their healthcare, and monitoring postpartum BP through in-person visits can be challenging due to barriers in care access," Christina Yarrington, MD, director of labor and delivery and the division director for maternal fetal medicine at Boston Medical Center, said in a press release. “Leveraging Rimidi and the connected blood pressure cuffs, which run on local cellular networks, our program has been able to significantly increase the number of BP measurements taken in the six weeks following delivery, a crucial component to proactively preventing adverse outcomes like heart attack and stroke.”

The program targets new mothers exhibiting evidence of high blood pressure, a leading cause of severe maternal morbidity and hospitalizations and a precursor to heart attacks and strokes. Operating within the hospital's Epic EHR platform, care teams monitor patients at home through a digital blood pressure cuff and telehealth platform, tracking patient data, adjusting care management as needed and offering on-demand communications with the patient.

Healthcare organizations are turning to RPM programs to improve care and clinical outcomes for at-risk patients by monitoring them at home, rather than waiting for them to attend follow-up visits with their care provider. The platform allows care teams to identify health concerns earlier and correct or manage them before they lead to a serious issue, such as hospitalization.

The platform is configured to alert the care team whenever a patient submits a reading outside the established threshold, as well as when a patient misses a reading or sends a message. It also alerts the care team when the six-month time period has been reached, so that the health system can take the patient off the program if her readings are good.

Over a six-month period encompassing treatment for 505 patients, the program logged 8,922 blood pressure readings, 913 high blood pressure alerts, and 174 low blood pressure alerts. In that time, care teams sent 700 messages to patients and received 93 messages from patients.

The health system also published an analysis in the American Heart Association journal Circulation of 1,008 patients treated between April 2020 and September 2021. They reported 98.7% of the patients submitted at least one blood pressure reading to caregivers (15 patients submitted no readings), with an average of 17.1 readings submitted per patient during the six-week period after delivery.

That study also examined how an RPM program could help underserved populations access care. Of the patients involved in the study, 40.5 percent identified as Black, 36.3% identified as Hispanic and 14.4% identified as white. Researchers found little difference in the average number of readings taken by the three groups, nor was there much different in the engagement level.

"Implementation of a cloud-connected BP monitoring program among a diverse, safety-net population was successful at ascertaining multiple BP measures in the postpartum period," the study concluded. "Furthermore, similar patterns of use across racial and ethnic groups suggest that this program could reduce disparities with respect to postpartum BP ascertainment."

With those results in hand, the health system is expanding the program to include monitoring for gestational diabetes, and will be sending patients home with cellular glucometers and real-time glucose monitors along with the digital blood pressure cuffs.