Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania, and Independence Blue Cross, Philadelphia, Pennsylvania.
Obstet Gynecol. 2023 Jun 1;141(6):1163-1170. doi: 10.1097/AOG.0000000000005197. Epub 2023 May 3.
To use administrative claims data to evaluate the association of a remote blood pressure monitoring program with adverse postpartum clinical outcomes in patients with a hypertensive disorder of pregnancy.
This was a retrospective cohort study of Independence Blue Cross members with a hypertensive disorder of pregnancy diagnosis across three obstetric hospitals from 2017 to 2021. Patients who were enrolled in twice-daily text-based blood pressure monitoring for 10 days postpartum were compared with two propensity-score matched cohorts of patients who met the program criteria: an asynchronous cohort (cohort A), consisting of patients at any of the three participating hospitals before remote monitoring program implementation, and a contemporaneous cohort (cohort C), consisting of patients at other hospitals during the same time period as clinical use of the program. Patients with less than 16 months of continuous insurance enrollment before delivery were excluded. Claims for adverse clinical outcomes after delivery discharge were evaluated. Health care service utilization and total medical costs were evaluated.
The 1,700 patients in remote blood pressure monitoring program were matched to 1,021 patients in cohort A and 1,276 in cohort C. Within the first 6 months after delivery, patients enrolled in remote monitoring were less likely to have the composite adverse outcome than those in cohort A (2.9% vs 4.7%; OR 0.61, 95% CI 0.40-0.98). There was no statistically significant difference relative to cohort C (3.2% vs 4.5%; OR 0.71, 95% CI 0.47-1.07). The remote monitoring group had more cardiology visits and fewer postnatal emergency department (ED) visits and readmissions compared with both comparison cohorts. Reductions in ED visits and readmissions drove overall lower total medical costs for the program cohort.
Patients enrolled in a remote blood pressure monitoring program were less likely to experience an adverse outcome in the first 6 months after delivery. Reductions in ED visits and readmissions resulted in lower postpartum total medical costs compared with both control cohorts. Broad implementation of evidence-based remote monitoring programs may reduce postpartum adverse outcomes, thereby reducing morbidity and mortality in populations such as the one studied here.
利用行政索赔数据评估远程血压监测计划与妊娠高血压疾病患者产后不良临床结局的关联。
这是一项回顾性队列研究，涉及 2017 年至 2021 年期间在三家产科医院就诊的患有妊娠高血压疾病的 Independence Blue Cross 会员。将接受产后 10 天内每天两次基于文本的血压监测的患者与符合该计划标准的两个倾向评分匹配队列的患者进行比较：异步队列（队列 A），由远程监测计划实施前的三家参与医院中的任何一家患者组成，同期队列（队列 C），由同期计划临床使用期间其他医院的患者组成。排除分娩前连续保险登记不满 16 个月的患者。评估产后出院后不良临床结局的索赔。评估医疗服务利用和总医疗费用。
远程血压监测计划中的 1700 名患者与队列 A 中的 1021 名患者和队列 C 中的 1276 名患者相匹配。在产后 6 个月内，接受远程监测的患者发生复合不良结局的可能性低于队列 A（2.9%比 4.7%；OR 0.61，95%CI 0.40-0.98）。与队列 C 相比，无统计学差异（3.2%比 4.5%；OR 0.71，95%CI 0.47-1.07）。与两个对照组相比，远程监测组的心脏病就诊次数更多，产后急诊就诊次数和再入院次数更少。ED 就诊和再入院次数的减少推动了计划组的总医疗费用降低。
参加远程血压监测计划的患者在产后 6 个月内发生不良结局的可能性较低。与两个对照组相比，ED 就诊和再入院次数的减少导致产后总医疗费用降低。广泛实施基于证据的远程监测计划可能会降低产后不良结局的发生率，从而降低研究人群等人群的发病率和死亡率。
