Abstract
Objective
The objective is to present stepwise refinements to HomeSafe, an Epic-tethered, population-health-coordinated postpartum pathway for blood pressure (BP) surveillance after hypertensive disease of pregnancy (HDP).
Study Design
HomeSafe was designed for HDP people identified during their delivery hospitalization. The program incorporated prepopulated orders for home BP measurement and submission through a smartphone application linked to the electronic health record (Epic). A population health coordinator (PHC) was integrated at Year 2 to support registry tracking, expanded digital support and metric-driven reviews. Study data were managed using REDCap (Research Electronic Data Capture); a secure, web-based application hosted by the Massachusetts General Brigham Digital Research Applications team. Year-to-year analyses were performed for BP submission and route, predictors of timely BP return (≥1 BP in 7 days), 6-week postpartum visit attendance, and clinical and demographic variables.
Results
Across 24 months, 640 postpartum HDP individuals were enrolled; 68.6% (439/640) submitted BP in a timely fashion. In Year 1, 44.9% of BPs submission was by Epic (44.9%), portal (8.2%), or phone (15.5%). No BP was submitted by 31.4%. With a PHC (Year 2), Epic-routed capture increased to 56.5%, and phone/portal-dependent routes decreased to 11.6% (p = 0.0006). Program enrollment increased from 245 to 485 (p < 0.001) without changes in delivery volume. Independent negative predictors of BP return were Black non-Hispanic race, public insurance, and multiparity; HDP subtype, delivery mode, antihypertensive use, and neonatal intensive care unit admission were not predictive. HomeSafe engagement strongly predicted 6-week postpartum visit attendance (89.9 vs. 65.4%, p < 0.0001).
Conclusion
HomeSafe, an EHR-tethered, postpartum BP surveillance pathway, when partnered with a population health management approach and a coordinator provides significant improvements in BP ascertainment, enrollment scalability, and 6-week postpartum engagement. Persistent disparities by race and insurance status highlight a need for equity-focused approaches.