Dr. Danielle Tate, Maternal Medical Director of the Tennessee Initiative for Perinatal Quality Care (TIPQC), recently spoke with Babyscripts Senior Medical Director, Dr. Lauren Demosthenes, about the value of using remote patient monitoring and mHealth to help care providers align with ACOG recommendations for care, support health equity, and address social determinants of health.
At 26.1 deaths for every 100,000 births, Tennessee has one of the highest rates of maternal mortality in the United States, ranked 41st among 50.
Black women in Tennessee are three times as likely to die from pregnancy-related complications as their white peers, and one-hundred percent of pregnancy-related deaths to Black women in the years surveyed were determined to be preventable.
With 25.5 percent of mothers in the state receiving inadequate prenatal care, preventable complications can quickly become life-threatening.
Tennessee is pursuing multiple initiatives to improve maternal health outcomes in the state, including payer/provider partnerships that deliver digital health tools to mothers to monitor vital data and support them on their pregnancy journey.
Below are some of the highlights from their conversation:
Digital care offers women more options for their care. The traditional model of prenatal care is a one-size-fits-all approach that does not leave room for the uniqueness of pregnancy. The Michigan Plan for Appropriate Tailored Healthcare in Pregnancy (MiPATH) started as a collaboration between the University of Michigan and ACOG to take a hard look at prenatal care, look at the traditional 12-14 visits and suggest that many of those visits could be replaced by virtual care, with the provider monitoring vital data like blood pressure remotely.
The panel (including Dr. Demosthenes) presented a tailored prenatal care model that provides patients with options for medical care, education and support during pregnancy, and suggests several options for reduced in-person visit schedules enhanced with remote patient monitoring.
More options = more equitable care. Babyscripts conducted a research trial aligned with ACOG guidelines for postpartum care, which recommend that women have a blood pressure check within 7-10 days after childbirth to identify hypertension complications. As a part of a fellowship with the Robert Wood Johnson Foundation, Dr. Demosthenes researched the effects of substituting physical postpartum BP checks with digital, at-home checks.
There was some institutional reluctance that patients would not be able to monitor their own levels at home, but her research found that a much greater percentage of mothers were able to adhere to BP monitoring at-home than the 60% of patients who returned to the office for an in-person BP check.
"We had one patient who was trying to get by with just one car between her and her partner, who had a baby at home — there are so many reasons why women don't make it back to that postpartum check. They're feeling okay or they're struggling with new motherhood -- they're much more capable of sticking to these guidelines with the at home cuff.
The ability to monitor vital data from home also improves the ability for women to receive care who are struggling with social determinants of health -- things that for the most part of totally out of the provider's control.
Remote patient monitoring empowers women to be more engaged in their care. Patient data from Babyscripts has shown that patients who are engaged with the app and monitoring/taking their own BP levels have improved attendance rates at postpartum visits. While there's no direct way to prove the connection, it does make sense that a patient more engaged with their care would be more involved with attending appointments.
Patients who are hypertensive during pregnancy are at higher risk of heart disease late in life, and chronic hypertensives should be taking their BP levels throughout their life. Pregnancy is a good entry point for developing habits that will help the patient through life.
Digital education keeps women secure with up-to-date information.
"I used to hand out the ACOG packet and hope that the patient would read it when they got home. Traditionally in an office appointment, you give a large amount of information to the patient and then you send them home, not seeing them again for about a month. That’s a fairly large gap."
With an app like Babyscripts, education is delivered to the patient's phone, with weekly updates, so the patient has daily, convenient support on their journey. Because medicine changes fairly quickly, the ability to update an app quickly (and cheaply) makes it much more efficient than a paper packet.
Babyscripts has the added capability of customizable campaigns, so that a practice can immediately deliver regional or practice specific information to their patients at any time, and a dashboard that shows providers which content in the app their patients are engaging with the most.
Remote BP monitoring covers all risk profiles. If a patient is low-risk, they don't need to be coming into the office constantly, which makes them a good candidate to stay at home and have a reduced schedule. Remote monitoring of BP provides the assurance of connection to the provider even without that in-person contact.
A patient who’s at high risk for preeclampsia is also a good candidate for using RPM, they can learn what’s normal in their BP, get used to taking care of it, establish their patterns, and then the health system can be alerted when the patient registers a level that is outside of their normal range.
Remote patient monitoring can often capture a more accurate reading for BP than in the office; considering the stress of getting to an appointment and potential white coat syndrome.
Successful innovation relies on open mindsets and collaboration. It’s hard to change mindsets and workflows. Babyscripts provides end-to-end support for health systems and providers because they want to make sure that the opportunity is supported through integration, training, messaging, and feedback.
Ready to start using virtual maternity care tools to improve outcomes for your practice? Interested in learning more about how Babyscripts supports practices in taking care of their maternity populations? Register for Babyscripts upcoming webinar on August 17, 12PM ET: