Abstract Body: Introduction
Postpartum hypertension is a leading cause of severe maternal morbidity and mortality. Approximately half of those with hypertensive disorders of pregnancy (chronic hypertension, preeclampsia, gestational hypertension) remain hypertensive after delivery and are at an increased risk of being readmitted to the hospital postpartum. Postpartum remote blood pressure monitoring (RBPM) may be an effective tool to reduce hospital readmission rates.
Hypothesis
Postpartum RBPM reduces both short-term (30 day) and long-term (1 year) hospital readmission rates.
Methods
We conducted an electronic medical record (EMR) based cohort study. We included patients who delivered between 2021-2023 with hypertensive disorders of pregnancy and were enrolled in an RBPM program (RBPM group). We used a comparison group of patients who delivered at the same hospital between 2016-2018, prior to the RBPM program (pre-implementation group), who would have been eligible to participate had the program been in place. Sociodemographic and pregnancy data were abstracted from the patient EMR. For analyses, we included deliveries ≥20 gestational weeks among patients aged ≥18 years. We evaluated risk of short- and long-term hospital readmission for 1) all-causes and 2) hypertension-related reasons. Log-binomial regression estimated risk ratios (RR) and 95% confidence intervals (CI) for the effect of postpartum RBPM on hospital readmissions.
Results
Among 4,948 patients (pre-implementation: n=2,807, RBPM: n=2,141), baseline characteristics were similar (non-Hispanic Black: 46% vs 46.3%, mean maternal age: 31 (SD 6.1) vs 30 (SD 6.1) years, respectively). The RBPM group had lower short-term readmission rates for all-causes (4.9% vs 5.7%) and hypertension-related reasons (4% vs 4.3%). The RBPM group also had lower long-term readmission rates for all-causes (6.9% vs 7.5%). In models adjusted for type of hypertensive disorder in pregnancy and age, the RBPM group had a lower risk of short-term readmission compared to the pre-implementation group (all-causes: RR 0.69 (95% CI 0.55, 0.89); hypertension-related: RR 0.70 (95% CI 0.53, 0.93)). The RBPM group was also less likely to be readmitted long-term compared to the pre-implementation group (all-causes: RR 0.76 (95% CI 0.62, 0.94); hypertension-related: RR 0.77 (95% CI 0.59, 0.98)).
Conclusions
In a diverse, safety-net population, postpartum RBPM reduced hospital readmissions within 30 days and 1 year following hypertensive disorders of pregnancy.