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Abstract
Objectives To improve timely follow-up after delivery hospitalization in patients with hypertensive disorders of pregnancy.
Methods A quality improvement initiative was enacted at a large academic medical center to ensure the safe discharge of postpartum patients with hypertensive disorders of pregnancy (HDP). The primary aim was to increase completion of a blood pressure (BP) visit within 7 days of discharge from 41% to 70% within 6 months for patients with HDP. Secondary measures included scheduled visits within 7 days, completed visits within 3 days for severe HDP, and no-show rates. Balancing measure was readmission rate. Statistical process control charts were employed for outcome analysis. We performed qualitative patient interviews with a focus on disparities.
Results Through patient interviews, process mapping, and a key driver diagram (figure 1), we identified a need for BP devices at discharge and patient education. In plan-do-study-act (PDSA) cycles, we simplified a process for care coordination, obtained BP devices to provide all patients with HDP at discharge, and established a remote blood pressure monitoring system. Completed and scheduled visits within 7 days of discharge improved from 41% to 68% (figure 2) and 61% to 92% (figure 3), respectively. Completed visits within 3 days improved from 9% to 47% (figure 4). No-show rates improved from 26% to 18% (figure 5), with non-Hispanic Black patients being 2.2 times more likely than non-Hispanic White patients to have a no-show visit at baseline (OR 2.2 CI 1.36–3.60, p=0.001). This disparity was not statistically significant post-intervention (OR 1.6, CI 0.74–3.49, p=0.228). Readmission rates remained steady at 3%.
Conclusions Timely and guideline-concordant follow-up of postpartum patients with HDP is challenging and requires modifications to our care delivery to provide a safe discharge. Our interventions, directed through patient feedback, could be considered as a novel patient-centered bundle to help achieve this goal.
Key driver diagram
Visits completed within 7 days of discharge in all patients with hypertensive disorders in pregnancy
Visits scheduled within 7 days of discharge for all patients with hypertensive disorders of pregnancy
Visits completed within 3 days of discharge for patients with severe hypertensive disorders of pregnancy
No-show visits for all patients with hypertensive disorders of pregnancy
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