AJP reports · 2026
Risk Stratification of Postpartum Patients with Hypertensive Disorders of Pregnancy to Telehealth Follow-Up: A Quality Improvement Project.
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Banuelos Ariana M, Ellison Kalin, Xiao Weirui, Chavez Patricia, Wolfe Diana S, Bortnick Anna E, Vani Kavita
Аннотация
BACKGROUND: Guidelines recommend a 3-day follow-up for severe hypertensive disorders of pregnancy (HDP) and a 7- to 10-day follow-up for nonsevere HDP, but implementation varies.
OBJECTIVE: To improve adherence to guideline-recommended postpartum follow-up by targeting provider discharge recommendations. A risk stratification tool incorporating HDP severity, maternal symptoms, and discharge blood pressure guided providers to recommend telehealth follow-up at 3, 5, or 7 days. We aimed to maintain 3-day recommendations for severe HDP and reduce unnecessary 3-day recommendations for nonsevere HDP.
STUDY DESIGN: This quality improvement project was conducted at a single urban academic institution. The risk stratification tool was integrated into discharge workflows, and demographic, clinical, and telehealth follow-up data for pre- and post-intervention cohorts were abstracted from the electronic medical record and compared using summary statistics and bivariate analyses.
RESULTS: Cohorts were similar at baseline. After implementation, all patients with severe HDP continued to receive 3-day follow-up instructions. Among patients with nonsevere HDP patients, 3-day recommendations decreased from 100 to 31.1% ( p < 0.001), with a corresponding decrease in 3-day telehealth scheduling. Scheduling for severe HDP did not improve.
CONCLUSION: The tool improved guideline-aligned provider recommendations for postpartum HDP. Scheduling changes were limited, suggesting future efforts should target workflow and system processes.
OBJECTIVE: To improve adherence to guideline-recommended postpartum follow-up by targeting provider discharge recommendations. A risk stratification tool incorporating HDP severity, maternal symptoms, and discharge blood pressure guided providers to recommend telehealth follow-up at 3, 5, or 7 days. We aimed to maintain 3-day recommendations for severe HDP and reduce unnecessary 3-day recommendations for nonsevere HDP.
STUDY DESIGN: This quality improvement project was conducted at a single urban academic institution. The risk stratification tool was integrated into discharge workflows, and demographic, clinical, and telehealth follow-up data for pre- and post-intervention cohorts were abstracted from the electronic medical record and compared using summary statistics and bivariate analyses.
RESULTS: Cohorts were similar at baseline. After implementation, all patients with severe HDP continued to receive 3-day follow-up instructions. Among patients with nonsevere HDP patients, 3-day recommendations decreased from 100 to 31.1% ( p < 0.001), with a corresponding decrease in 3-day telehealth scheduling. Scheduling for severe HDP did not improve.
CONCLUSION: The tool improved guideline-aligned provider recommendations for postpartum HDP. Scheduling changes were limited, suggesting future efforts should target workflow and system processes.