Kaiser Permanente plans to offer remote blood pressure monitoring for all pregnancies

Key takeaways:

• U.S. maternal mortality is among the highest of industrialized nations, especially among Black women.
• Uncontrolled high blood pressure can be a key factor in pregnancy-related complications.
• Remote hypertension monitoring coupled with blended virtual and in-office perinatal visits can help identify earlier and better hypertension control during pregnancy.

By Janet Byron
The Permanente Federation

High blood pressure, or hypertension, is linked to a range of complications in pregnancy, including the increased risk of seizures, bleeding complications, strokes, preterm birth, and even death. The United States has the highest maternal mortality rate among industrialized nations, with Black women 2 to 3 times more likely to die from pregnancy-related causes than white women, in part due to their higher prevalence of hypertension, according to the Centers for Disease Control and Prevention.

“The United States is dealing with a maternal mortality crisis,” says Ericka Gibson, MD, ob-gyn and perinatal safety physician lead with The Southeast Permanente Medical Group, which provides care to Kaiser Permanente members in Georgia. “By using remote tools to focus on the day-to-day management of hypertension — not just during perinatal visits — we can begin to address a root cause of pregnancy-related complications.”

Lessons learned from offering telehealth during the pandemic — coupled with a successful program targeting Black maternal health and high-risk pregnancies at Kaiser Permanente in Georgia — are now informing a new Kaiser Permanente perinatal care model that will offer remote hypertension monitoring with a blend of virtual and in-person care for low-risk pregnant members.

“The pandemic taught us that virtual health care can be provided safely and effectively across our large, diverse population,” says Nancy Gin, MD, executive vice president of quality and chief quality officer for The Permanente Federation. “And in Georgia we learned that our pregnant members also welcome the opportunity to use remote and online health care tools.”

Related article: Blood pressure patterns in early pregnancy tied to later risk of hypertension

Sprint to improve perinatal care

From April to mid-August 2020, a multidisciplinary team led by the Kaiser Permanente Care Management Institute’s design team in close partnership with Permanente physicians and operational partners did a quality-improvement “sprint” to quickly understand changes to perinatal care delivery during the COVID-19 pandemic and rapidly develop a new model for all low-risk pregnancies. Called KP Connected Pregnancy Care, the model is now scheduled to be scaled across all Kaiser Permanente regions this year.

“We sought to create a flexible model of perinatal care that provides embedded choices and options, giving mothers ownership of care that builds confidence and meets their needs, preferences, and values,” says Kari Carlson, MD, ob-gyn with The Permanente Medical Group in Northern California and Kaiser Permanente’s national clinical lead for women’s health and perinatal remote monitoring.

The new model for perinatal care features:

• Blended model of care, an intentionally sequenced set of in-person and virtual clinical care appropriate for low-risk patients.
• Remote monitoring, with Bluetooth-connected weight scales and blood pressure monitors provided to each patient that shares readings with their electronic health record via a mobile app, as well as a doppler device to check fetal heart tones.
• Single digital home, with seamlessly connected digital capabilities to support Kaiser Permanente members during their pregnancies.

“While these care options benefit all mothers, they are particularly important for women who struggle to get to prenatal appointments because they lack access to transportation or can’t afford to take time off work or pay for childcare,” Dr. Carlson says.

Related article: Coronavirus may double severe complications in pregnancy

Targeting for high-risk pregnancies

In 2019, obstetric patients with high blood pressure in Georgia — where 50% of maternity patients are Black and 23% develop hypertension — were given a Bluetooth-enabled blood pressure cuff for home use, which alerted their care teams via their electronic medical records when it was severely elevated.

The pandemic taught us that virtual health care can be provided safely and effectively across our large, diverse population.

— Nancy Gin, MD, FACP, chief quality officer, The Permanente Federation

In addition to remote hypertension monitoring, Kaiser Permanente Georgia’s perinatal program included the redesign of postpartum services and introduction of social workers and high-risk clinics.

“Our goal was to create a ‘cocoon’ around our pregnant people with high blood pressure,” Dr. Gibson says.

In the program’s first year, 736 pregnant people were enrolled and 638 severe-range alerts were received. As a result of the alerts, Kaiser Permanente induced labor 36 times to prevent possible poor outcomes for mothers and their babies.

Remote monitoring for high-risk pregnant members is available in Kaiser Permanente’s Georgia, Mid-Atlantic States, Northern California, and Colorado regions, and will be expanded to all regions by the end of 2022.

“The learnings from our efforts in Georgia demonstrated the safety and improved outcomes that could come with remote monitoring,” Dr. Gibson says. “We are pleased that all Kaiser Permanente members will now have the benefit of remote monitoring and redesigned perinatal services to ensure healthy pregnancies for all.”