Community-based, Family-centered, Trauma-informed Approach to Timely Detection and Management of Early Postpartum Hypertension

Yale University

Summary

The investigators primary project goal is to improve clinical outcomes, including mental health outcomes, among postpartum at-risk women experiencing health disparities by increasing awareness, detection, and timely care of postpartum hypertension, mental health and cardiovascular complications. The investigators will accomplish this by comparing the effectiveness of two multi-component multi-level healthcare delivery models focused on early detection and control of postpartum hypertension and the social and mental health factors known to impact maternal outcomes, with the current standard of care and with each other.

Description

This study will compare two interventions with the standard of care. Given that this is a stepped-wedge design, all sites will begin with recruitment for the standard of care. All study participants will be identified, recruited and enrolled during their postpartum hospital stay (i.e. prior to discharge) by research study staff. Once study participants are enrolled, they will receive a Omron blood pressure (BP) cuff and will be instructed on how to use it. General Design Description Overall study design. This project spans three states (Connecticut, Massachusetts, New York) and includes three…

Eligibility

Age range: 18+ years
Sex: Female
Healthy volunteers: No

Detailed criteria

Inclusion Criteria: * Delivery of singleton live birth (twins reduced to singleton or with vanishing twin syndrome prior to 14 weeks qualify) * Postpartum * English or Spanish speaking * Viable pregnancy 24 weeks of gestation or above (Child can be in NICU to participate) * Medicaid or the equivalent within each state (for example, Connecticut has Husky insurance) or uninsured * Must living in one of the three states involved in this study (Connecticut, Massachusetts, New York) and preferably within the geographical area of each of the hospitals Exclusion Criteria: * Multifetal pregnancy (s…

Interventions

Other
Remote Medical Model (RMM)
Remote home blood pressure (BP) monitoring once a day for the first 7 days and then at least weekly or more frequently as per a standardized blood pressure protocol up to six weeks and weekly virtual visits for 6 weeks and up to 12 weeks as needed by a physician extender (e.g. Nurse Practitioner, Pharmacist, etc.), and screening for social determinants of health and anxiety/ depression with referral for services if positive
Other
Community Health Model (CHM)
Utilization of community health workers trained in a strength-based trauma informed dyadic evidence-based approach.
Other
SoC
SoC for Postpartum Hypertension

Locations (3)

Yale New Haven Hospital
New Haven, Connecticut
University of Massachusetts Memorial Health
Worcester, Massachusetts
Oishei Children's Hospital University at Buffalo
Buffalo, New York