Reports From the Field

Rapid-Cycle Innovation Testing of Text-Based Monitoring for Management of Postpartum Hypertension

Journal of Clinical Outcomes Management. 2017 February;24(2)

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Patient engagement and cycle outcomes are individually detailed by cycle intervention below and summarized in Table 3 . Figure 2 compares patient responses meeting current ACOG recommendations for postpartum hypertension surveillance by cycle.

By Cycle

Cycle 1 - Basic

Cycle 1 tested our basic hypothesis that patients would take their blood pressure at home and transmit the results by text message: 5 of 7 patients responded to our reminders, each transmitting blood pressures on at least 5 of the 7 days requested.

Four severe-range blood pressures, defined as systolic blood pressure ≥ 160 mm Hg or diastolic blood pressure ≥ 110 [6], were sent to the physician responder, two times each in 2 patients. All four “at risk” severe blood pressures were addressed within 24 hours of the text message. No medications were initiated, as elevated blood pressures were not persistent and patients were asymptomatic.

Cycle 2 - Education

Patients in Cycle 1 reported during their follow-up interview that they became more aware of the possible morbidity associated with persistent postpartum hypertension as the cycle progressed. Therefore, Cycle 2 tested our hypothesis that focused education would improve patient engagement.

All five patients in this cohort sent in at least one blood pressure during the cycle period. All transmitted at least one blood pressure text on post-discharge day 1 or 2. Four of the five patients (80%) also sent in at least one blood pressure on day 5, 6, or 7.

There were no significantly elevated blood pressures sent to the physician responder.

Cycle 3 - Personalization

Patients in Cycle 2 reported during their interview that they felt the text message responses from the provider were too automated. Cycle 3 tested our hypothesis that added personalization, with patient and infant names included in the messages, would improve engagement.

Three of five patients in this cohort sent at least one blood pressure text on post-discharge day 1 or 2 (60%). Only one patient (20%) also sent in at least one blood pressure on day 5, 6, or 7.

One significantly elevated blood pressure was sent to the physician responder. This blood pressure was addressed within 24 hours of the text message. No medications were initiated, as elevated blood pressures were not persistent and patients were asymptomatic.

Cycle 4 - Response Timing

Patients in Cycle 3 had lower response rates than previous cycles and noted that they wanted more flexibility in the time to respond, as their schedules were unpredictable with a newborn at home. Although they enjoyed the personalized aspect, they did not feel it influenced their responses, which is evidenced by the low response rate on days 5, 6, or 7. Therefore, Cycle 4 tested our hypothesis that allowing patients to commit to a time of their choice for receiving the reminder texts would improve their response rate.

All five patients enrolled in this cohort sent in at least one blood pressure. We received at least one blood pressure text on post-discharge day 1 or 2 from all five patients in this cycle (100%). Three of the five patients (60%) also sent in at least one blood pressure on day 5, 6, or 7.