SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA.
Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Hospital, New York, NY, USA.
BMC Pregnancy Childbirth. 2024 May 14;24(1):358. doi: 10.1186/s12884-024-06564-2.
Hypertensive disorders of pregnancy (HDP) are the most common cause of postpartum readmission. Prior research led to clinical guidelines for postpartum management; however, the patient experience is often missing from this work. The objective of this study is to understand the perspective of patients readmitted for postpartum hypertension.
This was a qualitative study with data generated through semi-structured interviews. Patients readmitted with postpartum HDP at an urban academic medical center from February to December 2022 were approached and consented for an interview. The same researcher conducted all interviews and patient recruitment continued until thematic saturation was reached (n = 9). Two coders coded all interviews using Nvivo software with both deductive and inductive coding processes. Discrepancies were discussed and resolved with consensus among the two coders. Themes were identified through an initial a priori template of codes which were expanded upon using grounded theory, and researchers were reflexive in their thematic generation.
Six themes were generated: every pregnancy is different, symptoms of preeclampsia are easily dismissed or minimized by both patient and providers, miscommunication regarding medical changes can increase the risk of readmissions, postpartum care coordination and readmission logistics at our hospital could be improved to facilitate caring for a newborn, postpartum care is often considered separately from the rest of pregnancy, and patient well-being improved when conversations acknowledged the struggles of readmission.
This qualitative research study revealed patient-identified gaps in care that may have led to readmission for hypertensive disorders of pregnancy. The specific recommendations that emerge from these themes include addressing barriers to blood pressure management prior to discharge, improving postpartum discharge follow-up, providing newborn care coordination, and improving counseling on the risk of postpartum preeclampsia during discharge. Incorporating these patient perspectives in hospital discharge policy can be helpful in creating patient-centered systems of care and may help reduce rates of readmission.
妊娠高血压疾病（HDP）是产后再入院的最常见原因。先前的研究导致了产后管理的临床指南；然而，患者的体验通常在这项工作中缺失。本研究的目的是了解因产后高血压而再次入院的患者的观点。
这是一项定性研究，数据来自于半结构化访谈。2022 年 2 月至 12 月，在一家城市学术医疗中心，对因产后 HDP 再次入院的患者进行了接触并同意接受访谈。同一位研究人员进行了所有访谈，并且在达到主题饱和度时继续招募患者（n=9）。两名编码员使用 Nvivo 软件对所有访谈进行编码，使用演绎和归纳编码过程。差异由两名编码员通过讨论和共识解决。主题是通过最初的先验模板代码确定的，然后使用扎根理论扩展这些代码，研究人员在主题生成方面具有反思性。
产生了六个主题：每个妊娠都不同，先兆子痫的症状很容易被患者和提供者忽视或最小化，关于医疗变化的沟通不畅会增加再入院的风险，我们医院的产后护理协调和再入院后勤工作可以得到改善，以方便照顾新生儿，产后护理通常与妊娠的其余部分分开考虑，当对话承认再入院的困难时，患者的幸福感会提高。
这项定性研究揭示了患者认为可能导致妊娠高血压疾病再次入院的护理差距。这些主题中出现的具体建议包括在出院前解决血压管理障碍，改善产后出院随访，提供新生儿护理协调，并在出院时改善关于产后子痫前期风险的咨询。在医院出院政策中纳入这些患者观点有助于创建以患者为中心的护理系统，并可能有助于降低再入院率。
