Using RE-AIM to inform the adaptation of a clinical decision support application for hypertension disorders of pregnancy: a qualitative study of provider perspectives.

BACKGROUND

Hypertensive disorders of pregnancy (HDP) are significant contributors to maternal morbidity and mortality in the United States, which has one of the highest maternal mortality rates among high-income nations. Home blood pressure monitoring (HBPM) offers promise for improving care, but its integration into workflows is poorly understood. This study explores clinicians' perspectives and identifies implementation challenges for an HDP-specific app.

METHODS

We used a snowball approach to invite perinatal clinicians at a large academic health center to participate in qualitative interviews focused on HBPM practices, data integration into electronic health records (EHRs), and adapting a Collaboration Oriented Approach to Controlling High Blood Pressure (COACH) application for perinatal care (P-COACH). A team of researchers used a hybrid qualitative approach to deductively apply the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to data collection, organization, and presentation of results. An inductive approach was then used to identify themes within each RE-AIM domain.

RESULTS

Seven participants highlighted the app's potential to expand care access, particularly for underserved populations, where factors such as rural clinic closures and transportation are barriers. Home BP monitoring could aid in timely risk assessment, early detection of complications, and medication adjustments. Pregnancy was seen as a unique opportunity to encourage health behavior changes. Concerns included liability, alert fatigue, and patient anxiety. Successful implementation requires seamless integration with the patient and clinical workflows, appropriate alerts, and considering end-user needs.

DISCUSSION

Digital health tools like COACH have broader applicability in addressing gaps in chronic disease management, leveraging patient-generated data to improve care quality and efficiency. Clinicians noted that such tools could alleviate perinatal provider workload by reducing unnecessary visits and timely interventions. However, challenges like integrating tools into complex workflows, overcoming usability barriers, and addressing resource disparities must be prioritized. Future efforts should consider tailoring tools to ensure cultural and contextual relevance to promote equitable adoption and sustained engagement.

CONCLUSIONS

Adapting P-COACH offers a unique opportunity to address gaps in hypertension care during pregnancy. By focusing on equitable implementation and scalability, future work can refine this tool to improve outcomes, ensure sustainability, and enhance support for underserved populations, ultimately advancing maternal health in diverse clinical settings.

CLINICAL TRIAL NUMBER

Not Applicable.