The lack of obstetric services impacts more than 27 million women and infants in the US and represents significant resource and financial burdens for primarily rural states. Hypertension (HTN) in pregnancy including preeclampsia (PEC) is a major health problem and is associated with significant increased severe maternal morbidity (SMM) and mortality (MM). Management of a chronic condition such as HTN, especially in a pregnant population residing in rural areas, can have a significant impact on optimal maternal/neonatal outcomes. However, the use of advanced telecommunication technologies to support and promote long-distance clinical health care, including telehealth and remote patient monitoring (RPM) can provide rural areas with specialty health care services that can increase the quality of care, reduce costly readmissions and emergent care visits, and lower healthcare disparities. The University of Arkansas for Medical Sciences (UAMS), the only academic health science center in the state, serves as one of the only referral sources for high- risk pregnancies from rural Arkansas. Many of these women travel up to 4 hours one-way for prenatal visits. Not only does this distance from the healthcare team place a burden on the patient financially, it also poses as a barrier to receive timely interventions to pregnant women who require them. UAMS has nearly 15 years of experience pioneering telemedicine (TM) in a primarily rural state, Arkansas (AR). This proposed application aims to develop and test a protocol to test an integration of RPM for monitoring blood pressure (BP) in pregnant women with elevated BP into the standard of care in rural TM clinic for high-risk pregnancies which is supported by a 24/7 Call Center(CC). This proposal in line with goals of the Administrative Supplement to Expand Research Focused on Maternal Mortality and pregnancy-associated morbidity in the U.S. to strengthen evidence-based care and prevention strategies and improve outcomes in low-resource settings and high burden populations (e.g., racial/ethnic and/or rural) within the U.S. Additionally, this proposal aligns with the mission of CTSA U01 grant which includes expanding clinical and translational research opportunities across the lifespan and in underrepresented populations along with expanding the impact of clinical and translational research in and with rural populations. Overall goals is to improve care for pregnant women with HTN who live in rural, low-health resource areas by integrating RPM into current TM services. Therefore, we propose to demonstrate that an integrated TM+CC+RPM system with multi-level intervention will improve patients' compliance and patient care while addressing disparities in maternal morbidity and mortality. The study's aims include:
Aim 1 : Develop a self-monitoring RPM protocol that integrates into the existing IDHI rural telemedicine (TM) clinic and call center (CC) model for monitoring HTN in pregnancy. (TM + CC+ RPM) Aim 2: Implement the integrated model and assess participants' satisfaction toward the RPM device and the integrated system using a mixed-method approach.

Public Health Relevance

This multidisciplinary study proposes to test an integration of remote patient monitoring (RPM) for blood pressure (BP) in rural pregnant women with elevated BP into standard care of high-risk pregnancies provided by telemedicine based clinic and (ANGELS) Call Center (CC) at the University of Arkansas for Medical Sciences. We will to demonstrate feasibility, patients? satisfaction, and efficiency of using of RPM in pregnant women with elevated BP living in rural locations, which has the potential to improve maternal/fetal care while addressing disparities in maternal morbidity and mortality.

National Institute of Health (NIH)
National Center for Advancing Translational Sciences (NCATS)
Linked Specialized Center Cooperative Agreement (UL1)
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Zhang, Xinzhi
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University of Arkansas for Medical Sciences
Schools of Medicine
Little Rock
United States
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