Heart Safe Motherhood is a first-of-its-kind text message-based program designed at Penn Obstetrics and Gynecology to alert clinicians to women at risk for hypertension in the postpartum.
The program was developed by Drs. Adi Hirshberg, an Assistant Professor of Clinical Obstetrics and Gynecology, and Sindhu K. Srinivas, Director, Obstetrical Services at the Hospital of the University of Pennsylvania (HUP), and Vice Chair for Quality and Safety at Penn Ob/Gyn.
In the days following birth, the circumstances of birth and delivery place women with pregnancy-related hypertension (e.g., preeclampsia) at particular risk for stroke, neurovascular damage and death. While these outcomes can be avoided, hypertension is a silent disease — which may account for the fact that historically, ~70 percent of women at Penn Ob/Gyn opt out of attending their first follow-up appointment in the days after delivery.
Recognizing this concern, Drs. Hirshberg and Srinivas stuck upon the concept of communicating directly with their patients — but not by bringing them in for follow-up visits.
"We wanted a program that met women in their own homes," Dr. Srinivas says. So together, she and her program partner arrived at what Dr. Hirshberg describes as a simple idea." We're all on our cell phones all the time texting," she says. "And people take blood pressure readings at home every day — so we thought we'd combine the two to see if we could manage postpartum hypertension risk."
Heart Safe Motherhood thus provides a blood-pressure cuff and individual training on its use to new mothers before they leave the hospital for home. At home, each patient receives a text reminder twice daily for two weeks to check her blood pressure. These readings are then sent to Penn Ob/Gyn. Women are notified when elevated values occur, and asked to take and transmit additional readings. If these readings indicate the possibility of an acute event, the women are required to seek immediate medical attention.
Of the 1,400 women enrolled in Heart Safe Motherhood since its inception, more than 85 percent have reported their blood pressure at least twice within the first 7 to 14 days. Of these, about 15 percent have resulted in intervention.
Honors for Heart Safe Motherhood
Heart Safe Motherhood won five innovation-focused awards in 2018. The program earned a Clinical Innovation Award from Vizient, as well as placed second in the American Hospital Association's 2018 Innovation Challenge. Both awards recognize inventive solutions that improve patient experience.
Drs. Srinivas and Hirshberg were also recognized for their leadership with a first prize award in the American Heart Association's Philadelphia Heart Science Forum Innovation Challenge, Digital Health Category, and first place in the Council on Patient Safety in Women's Health National Improvement Challenge on Hypertension in Pregnancy.
Philadelphia Business Journal named Dr. Hirshberg a Health Care Innovator for her role in the development of Heart Safe Motherhood.
Setting the Standard
Heart Safe Motherhood is now the standard of care for obstetric patients at HUP, Pennsylvania Hospital, and Princeton Medical Center, with plans to scale to other Penn Medicine locations in 2019. Drs. Hirshberg and Srinivas, along with their team, are partnering with other health systems, payors, and vendors to evaluate if the program can be rolled out nationally.
The success of Heart Safe Motherhood also has prompted us to think of other ways to translate this approach to meet a variety of other needs, such as depression screening or breastfeeding support.
"Other people have really caught on to the fact that women are busy after delivery but they still need help, and text messaging is an easy and effective way get in touch with them," Dr. Hirshberg said. "They can't get to the office or they have so many other things going on. Why not see if it helps address other concerns and problems that women have after having a baby?"