By Sarosh Rana, MD, MPH, Professor of Obstetrics and Gynecology, University of Chicago Medicine
Editor’s note: The University of Chicago Medicine was recently recognized with the 2023 Bernard J. Tyson National Award for Excellence in Pursuit of Healthcare Equity for its initiative “Systematic Treatment and Management of Postpartum Hypertension (STAMPP-HTN),” which improved postpartum care for women with hypertensive disorders of pregnancy. Learn more about the Tyson Award and UChicago Medicine’s recognition.
Postpartum hypertension is a serious concern, especially for women who have experienced hypertensive disorders of pregnancy. If left unmanaged, it can lead to complications like heart failure and stroke, with long-term effects on heart health. Unfortunately, postpartum follow-up rates have historically been low, with Black women facing even greater challenges. To address this, the University of Chicago Medicine launched the Systematic Treatment and Management of Postpartum Hypertension (STAMPP-HTN) program to tackle these issues head-on, with the goal to enhance postpartum care, manage blood pressure effectively, and eliminate racial health disparities.
Comprehensive Approach
STAMPP-HTN is changing the course of action for postpartum patients. Since 2019, we’ve implemented a comprehensive approach, including:
- Patient education
- Dedicated nurse educators
- Training for all care providers
- Updated clinic protocols
- Home blood pressure monitoring kits
- Consistent scheduling of follow-up appointments
STAMPP-HTN has proven successful. Adherence to postpartum hypertension visits significantly improved following full implementation of the intervention bundle compared with pre-intervention adherence rates; overall visit attendance increased from 33.5% to 59.4% (P < 0.0001). For Black patients, visit attendance increased from 30% to 54.9%, and for white patients, 53.6% to 76.2%. While we found the postpartum follow-up rate improved from following this initiative, the preexisting racial disparity in the follow-up rate did not change, with a persistent disparity in the post-implementation group with a racial gap of 21.3%.
Changes in Patient Monitoring
In 2020, the COVID-19 pandemic pushed us to embrace telehealth visits, whereby we converted in-person postpartum hypertension visits to telehealth appointments. By the post-telehealth period, the visit adherence for Black patients increased to 76.3% and for white patients it increased to 76.7%, leaving only a 0.4% racial gap (P=.97) and eliminated disparity. In 2021, we introduced home blood pressure telemonitoring and remote patient monitoring, which allowed for real-time feedback and optimized therapeutic regimens, resulting in a reduction of Stage 2 hypertension from postpartum week one to week six, all while maintaining high follow-up rates without increasing disparities. Our patients have reported positive experiences with remote patient monitoring for postpartum blood pressure management, and we're constantly investigating survey responses and clinical outcomes. Community health workers have played a crucial role in enhancing follow-up rates for non-compliant patients with hypertensive disorders of pregnancy, underscoring their value in the program.
Scaling Out
STAMPP-HTN's success has spurred replication and expansion at various institutions nationwide, and it's become the gold standard here at the University of Chicago Medicine. Our future plans include extending the program to one year postpartum, implementing remote patient monitoring for early diagnosis and treatment of pregnancy-related hypertension, collaborating with the Illinois Department of Public Health for statewide implementation, and continuing to lead the charge in maternal healthcare transformation.
Disparity Dissemination
Beyond postpartum hypertension, this program serves as a model for addressing healthcare disparities across various medical domains. By incorporating telehealth, remote monitoring, and community health workers, STAMPP-HTN offers a blueprint for creating sustainable solutions to improve healthcare outcomes for underserved populations. This program carries the promise of saving lives and enhancing the long-term health of women who have experienced hypertensive disorders during pregnancy. As it continues to evolve and expand, it paves the way for a future where healthcare disparities are lessened, and every individual receives equitable care.
Sarosh Rana, MD, MPH, is a Professor of Obstetrics and Gynecology and Chief of the Section of Maternal-Fetal Medicine at the University of Chicago Medicine. She was recently named the inaugural Chief Obstetrical Transformation Officer for the UChicago Medicine health system. Dr. Rana cares for women with high-risk pregnancies and is an expert in the diagnosis and management of preeclampsia — a condition characterized by high blood pressure during pregnancy.
Dr. Rana aims to improve maternal and fetal outcomes through research on preeclampsia, and as a dedicated teacher, Dr. Rana trains residents and fellows in the management of women with complex pregnancies.