Examining the Implementation of an Educational Discussion Guide for Hypertensive Postpartum Patients

Background and Significance

After hypertensive pregnancies, many birthing people are at increased risk of premature cardiovascular disease (CVD; Abalos et al., 2013). The transition period from obstetric care to primary care is a crucial point in the care continuum for teaching hypertension management and its benefits for longer-term improved outcomes in cardiovascular health (Phillips et al., 2022). With the rise of maternal cardiovascular mortality in the weeks after delivery and greater risks of chronic hypertension, hyperlipidemia, and cardiovascular disease in the months and years after a hypertensive pregnancy, there is a demand for improved programs for vulnerable, underserved populations immediately postpartum and into the "fourth trimester" (Phillips et al., 2022; Henderson et al., 2016). The Maternal Fetal Medicine Cardiometabolic Postpartum Clinic at Brigham and Women's Hospital (BWH) has identified gaps in knowledge and opportunities for better transitions of care from obstetricians to primary care providers (PCPs). Under the direction of Ann Celi, MD, the investigators plan to implement a program that will create improved healthcare delivery models that can be replicated locally, nationally, and internationally, resulting in better care for patients in the postpartum period. Through this work, key elements of care are being identified and thoughtful approaches are being considered to improve care. The investigators have developed a nationally and internationally recognized sustainable model with excellent appointment attendance and adherence for a racially and socioeconomically diverse patient population. This work includes a recent shift to a successful virtual platform for increased outreach to rural and vulnerable, underserved communities, including maternal health deserts. Additionally, a previous study by the investigator involved semi-structured stakeholder interviews (N=28) of patient perspectives on postpartum care at 12 BIDMC-affiliated prenatal care sites. Qualitative analysis identified themes related to key barriers and facilitators to the implementation of best practices for postpartum care, including a lack of patient understanding of postpartum care and recovery after a complicated pregnancy.

Therefore, the investigators have developed a patient discussion guide in partnership with key stakeholders from professional societies, patient advocacy foundations, and thought leaders to address these gaps in patient knowledge regarding their postpartum care and recovery and to empower patients to engage in positive health behaviors and with their primary care providers (PCPs) after transitioning from obstetric to primary care. In this study, the investigators aim to measure postpartum patients' self-reported knowledge, activation, and satisfaction related to their postpartum care, recovery, and education before participants review the discussion guide and 4-12 weeks after the participants received the discussion guide. The investigators will compare these patient knowledge, activation, and satisfaction outcomes to that of a control group that receives the discussion guide 4-12 weeks later at the time of re-contact. The investigators will also examine clinical outcomes in all study patients during the postpartum period, including blood pressure readings and number of OB and PCP visits attended, to understand patients' health behaviors and follow-up with healthcare providers. Lastly, the investigators aim to gather patient feedback on the discussion guide from the participants, any family or support people, and/or their clinical care team, as well as any barriers or facilitators for their postpartum care and recovery.

Building upon the insight gained in this study, the goal is to further disseminate these activities for the benefit of patients beyond the region. The overarching goal of this postpartum healthcare delivery program is to incorporate its components into the best care delivery models broadly. BWH is uniquely positioned to develop and lead this program as it aligns with the hospital's commitment to diversity, equity, and inclusion in clinical care, research, and educational programs.

Aims and Objectives