HHS Selects Phase 1 Winners of Competition to Decrease Rates of Hypertension among Pregnant and Postpartum Women
New initiative to identify programs that provide effective monitoring and follow-up care for hypertensive disorders during pregnancy and postpartum.
The U.S. Department of Health and Human Services (HHS) Office on Women’s Health announced the 20 winners of Phase I of the HHS Hypertension Innovator Award Competition. The competition was created to identify effective, pre-existing programs that care for people with hypertension where the programs could be or are already applied to women with hypertension who are pregnant and/or postpartum. The goal of the competition is to demonstrate sustainability and the ability to replicate and/or expand programs that provide effective monitoring and follow-up of hypertension for women who are pregnant and/or postpartum.
Hypertension is a serious health condition affecting 1 in 10 women during pregnancy. If not controlled, hypertension puts women at higher risk of experiencing serious pregnancy complications and at higher risk of lifelong cardiovascular disease.
“The Hypertension Innovator Award Competition awardees will help us not only address hypertension but also improve maternal health and health equity in communities most at-risk for adverse health outcomes. The HHS hypertension challenge represents a step towards HHS reaching its goal to improve maternal health in America,” said ADM Rachel L. Levine, HHS Assistant Secretary for Health.
The competition is divided into three phases. During Phase I, HHS identified successful programs that provide effective care for hypertensive disorders. Phase II is upcoming and focuses on demonstrating that the programs awarded in Phase I can be applied to more women who are pregnant and/or postpartum, resulting in positive outcomes. During Phase III, applicants will demonstrate that programs have been successfully replicated and/or expanded in communities or clinical settings.
“Cardiovascular disease continues to be the leading cause of maternal death and is responsible for over 33 percent of pregnancy-related deaths,” said Dorothy Fink, M.D., Deputy Assistant Secretary for Women’s Health and Director, Office on Women’s Health. “Both maternal and infant mortality are key indicators of health and wellness within communities. If we can expand access to care and innovative treatments during pregnancy and after delivery, we create healthier futures for mothers, their babies, and their families.”
The 20 winners of Phase I of the HHS Hypertension Innovator Award Competition are listed below:
- Baltimore Healthy Start – Baltimore, MD
Program/Focus: Baltimore’s Safer Childbirth Cities Initiative
This program services more than 20,000 pregnant and postpartum women and utilizes comprehensive home-based case management and care coordination throughout the prenatal and postpartum periods to identify clinical risk factors, like preeclampsia, and other forms of maternal morbidity. This program succeeded in improving hypertension in pregnancy, with 31.1% showing improvement in blood pressure readings throughout their time in the program.
- Boston Medical Center – Boston, MA
Program/Focus: Remote Cloud Connected Postpartum Blood Pressure Monitoring Program
This program uses a partnership with a cloud-based software platform to identify high-risk women at Boston Medical Center and provide them with a cloud-connected blood pressure cuff for six weeks following their discharge from delivery hospitalization. Participation rates have exceeded 95% for this program and led to the early detection and immediate management of severe range blood pressures among 21% of its high-risk patients.
- Brigham and Women's Hospital – Boston, MA
Program/Focus: Improving outcomes by empowering women after hypertensive pregnancy
This program focuses on the transition from obstetric to primary care among a racially and socioeconomically diverse patient population (33.0% African American patients and 26.5% Hispanic). The clinic provides home blood pressure monitors for all hypertensive postpartum patients. Over the first five years of operation, the clinic increased the provision of blood pressure monitors from 56.8% to 93.8% among its patients and pairs this provision with in-clinic discussions about nutrition and heart-healthy lifestyles.
- CommonSpirit Health – Chicago, IL
Program/Focus: The Perinatal Hypertension Initiative
This program started as a quality improvement project and found an increase in compliance from 50.5% to greater than 90% with treatment recommendations for hypertensive pregnant women throughout the program. This was done through a combination of three strategies: treatment of critically elevated blood pressures within 30 minutes of verification, use of magnesium sulfate in the presence of critically elevated blood pressures (regardless of other criteria for preeclampsia being present), and early postpartum follow-up visit/assessment for hypertensive disorders of pregnancy. This program is being replicated across 65 other hospitals with maternity centers.
- Emagine Solutions Technology – Tucson, AZ
Program/Focus: The Patient Pregnancy Health Tracker App
This program utilizes a free cell phone application that allows participants to log their symptoms such as headaches, nausea, shortness of breath, and vitals including blood pressure, weight, and temperature. This information is then fed directly into the clinic’s interface, where providers can monitor their patients and respond in real-time.
- Gateway YMCA – Elizabeth, NJ
Program/Focus: YMCA’s Blood Pressure Self-Monitoring (BPSM) Program
This program uses Blood Pressure Self-Monitoring (BPSM) during a four-month timeframe. It helps patients with high blood pressure to better manage their blood pressure, build self-efficacy, identify and control triggers that elevate their blood pressure, and increase positive attitudes towards adopting healthier eating habits to reduce hypertension. As a result of this program, 35% of program participants achieved a controlled blood pressure reading, 83% of participants monitored their blood pressure at least twice a month, and 69% reported sharing their blood pressure readings with their healthcare provider.
- Healthcentric Advisors – Providence, RI
Program/Focus: Digital Solutions for Self-Measured Blood Pressure (SMBP)
This program offers a suite of digital solutions to improve the management and clinical outcomes of high-risk maternal health patients. It uses HIPAA-compliant devices to send information to the patient's physician-provided health information portal. Utilization of this system led to a 54% increase in control of hypertension in participants. It is also used to remotely monitor for pre-eclampsia, chronic hypertension, weight, gestational diabetes, and COVID-19 symptoms.
- Lehigh Valley Health Network – Allentown, PA
Program/Focus: Comprehensive Program for Hypertensive Disorders of Pregnancy
This program began as an existing telehealth program for non-pregnant patients with chronic heart disease that was expanded to include postpartum women. This telehealth program eliminated barriers to healthcare access, such as transportation and childcare, by providing an alternative to in-office visits.
- New York City Health + Hospitals – Manhattan, NY
Program/Focus: Hypertension Treat to Target Program
This program was implemented in one of the largest public health care systems in the nation. It is a four-month, primary care-based hypertension management program that has significantly improved patients’ blood pressure control. 74% of participating patients achieved blood pressure control in 2018 compared to 67% in 2014. These outcomes have been achieved by partnering participants with a registered nurse who works with them over a four-month period to achieve their blood pressure goal, in collaboration with the patient’s primary care provider.
- Novant Health – Charlotte, NC
Program/Focus: Novant Health Hypertension Challenge
This program developed protocols, standing orders, and order sets to urgently treat severe range hypertension (SHTN). It also educates health care teams about hypertension in pregnancy and the use of the protocol and standing orders. These changes aim to identify social determinants of health gaps such as food scarcity, transportation difficulty, or housing concerns and led to the capture of over 10,000 unique SHTN episodes.
- Nurse-Family Partnership – Denver, Colorado
Program/Focus: Client-Centered Nurse Home Visitation to Control Pregnancy-Induced Hypertension
This program uses a team of nurses to assess, monitor, educate, and advocate for patients to control pregnancy-induced and postpartum hypertension. Their primary population is low-income women who are pregnant for the first time. Participants in this program have experienced 35% fewer cases of pregnancy-induced hypertension in comparison to non-participants.
- Ochsner Health – New Orleans, LA
Program/Focus: Digital Hypertension Medicine Program
This program provides patients with a wireless digital blood pressure cuff that is compatible with smart phones (via Bluetooth) and allows blood pressures to be uploaded to their electronic health record. It tracks blood pressure measurements in relation to individual patient goals and alerts patients and program managers if certain thresholds are exceeded. The program achieved blood pressure control in 71% of the patients compared to 31% in the traditional care group.
- Preeclampsia Foundation – Melbourne, FL
Program/Focus: The Cuff Kit
This program focuses on self-monitoring of blood pressure, particularly for women at highest risk of developing a hypertensive disorder of pregnancy. The use of BP monitors enables providers to respond more rapidly to indications of gestational and postpartum hypertension, including preeclampsia. This program delivered over 7,700 blood pressure kits across 14 states. 69% of the kits which were delivered to women of racial and ethnic backgrounds.
- University of Chicago – Chicago, IL
Program/Focus: Systematic Treatment and Management of Postpartum Hypertension
This program utilizes a combination of strategies to decrease hypertension which includes: educating healthcare providers, adding standardized protocols and checklists for nurses, and creating a network between OB/GYN, cardiology, and emergency departments. 80% of past program participants were Black or African American and showed a significant decrease in hypertension at the first postpartum visit from 39.1% to 18.5%.
- University of Michigan – Ann Arbor, MI
Program/Focus: Expanding Cardio-Obstetrics
This program strives to improve care coordination across multiple disciplines for women with pre-existing hypertensive disease and other cardiac risk factors in pregnancy and postpartum. The program also engages health care providers across specialties to guide and empower patients throughout the pregnancy continuum. Examples of services offered include: free blood pressure cuffs, blood pressure logs, phone check-ins, telehealth and in-person visits, and lifestyle counseling.
- University of Pennsylvania – Philadelphia, PA
Program/ Focus: Heart Safe Motherhood (HSM)
This program focuses on care during the first ten days post-delivery and utilizes a text message-based platform that sends automated twice-daily reminders for patients to check their blood pressure using a hospital-provided blood pressure monitor. This program provides eedback for blood-pressure readings sent to the program based on a provider-determined algorithm that provides information regarding patient-specific blood pressure trends and allows providers to adjust care plans between office visits. The program found a significant increase in the ability to obtain at least one blood pressure reading within ten days after patients were discharged. Over 90% of black and non-black women in the HSM texting program had at least one blood pressure reading compared to 33% of black women and 70% of non-black women who attended their office visit in the usual care arm.
- University of Pittsburgh – Pittsburgh, PA
Program/ Focus: Remote Blood Pressure Monitoring in Postpartum Women after Hospital Discharge
This program serves over 3,000 women with hypertensive disorders related to pregnancy. It enrolls select patients in a remote hypertension monitoring program that utilizes a nursing call center which records and manages their hypertension through treatment algorithms. Analyzed data shows 90% of participants reported their blood pressure after four weeks postpartum compared to 66% in the control population and had a 5.4% readmission rate compared to an 8.1% rate in the control group.
- University of Wisconsin – Madison, WI
Program/Focus: Staying Healthy After Childbirth (STAC)
This program helps new moms with high blood pressure to safely monitor and treat their high blood pressure from the comfort of their home with remote patient monitoring and telehealth support from a dedicated team of health professionals. The program led to a significant reduction in HTN-related postpartum hospital readmission in the intervention compared to the control group (0.5% vs 3.7%) and has been replicated in 1,500 other women who have participated since its original design.
- University of Texas (UT) Health Science Center – Houston, TX
Program/Focus: A Multidisciplinary Postpartum Evaluation Opportunity- Newborn Visits
This program uses newborn visits at their pediatric clinics as a portal to evaluate maternal blood pressure and symptomatology to decrease maternal morbidity and mortality (both acute and long term) related to hypertensive disorders of pregnancy. The program serves a racially and ethnically diverse population with 75% of their patient base being Black and Hispanic women from socio-economically disadvantaged communities. Through the program’s efforts, the detection rate of postpartum preeclampsia with severe features increased from 1.8% to 3% among patients.
- Valleywise (in collaboration with Creighton University) – Phoenix, AZ
Program/Focus: Outpatient Telehealth and Remote Blood Pressure Cuffs to control Hypertensive Disorders of Pregnancy
This program utilizes a telemedicine approach to follow-up with women following a diagnosis of hypertensive disorder during pregnancy. Their research found that 92% of patients had a follow-up appointment scheduled, but only 60% followed through with that appointment. The program increases access to care and serves a very diverse population with 89% of their Labor and Delivery patients representing Black or African American, Hispanic, Asian, American Indian or Alaska Native, and Native Hawaiian and Pacific Islander populations.