PDF(Pubmed)
Abstract：
Background: Whether remote blood pressure (BP) monitoring can decrease racial disparities in BP measurement during pregnancy and the postpartum period remains unclear. This study evaluated whether Black and White patients enrolled in the Connected Maternity Online Monitoring (CMOM) program showed improvements in BP ascertainment and interval. Methods: A retrospective cohort of 3,976 pregnant patients enrolled in CMOM were compared to matched usual care patients between January 2016 and September 2022 using electronic health record data. The primary outcomes were BP ascertainment (number of BP measurements) and BP interval (time between BP measurements) during pregnancy and the postpartum period. The proportion of patients with a hypertensive disorder of pregnancy who checked their BP within 7 days of discharge following delivery was also assessed. Results: Enrollment in CMOM was lower among Black patients than White patients (42.1% vs 54.7%, P<0.0001). Patients in the CMOM group had more BP measurements than patients in the usual care group during pregnancy (rate ratio=1.78, 95% CI 1.74-1.82) and the postpartum period (rate ratio=1.30, 95% CI 1.23-1.37), with significant improvements for both Black and White patients enrolled in CMOM compared to patients in usual care. The CMOM intervention did not result in an improvement in 7-day postpartum adherence to checking BP for Black patients (risk ratio=1.03, 95% CI 0.94-1.11) as it did for White patients (risk ratio=1.09, 95% CI 1.01-1.17). Conclusion: Remote BP monitoring programs are a helpful tool to improve the frequency of BP measurements and shorten intervals between measurements during the prenatal and postpartum periods for all patients. Future evaluation is needed to determine the barriers to offering the program to and enrolling Black patients.
摘要：
背景：远程血压（BP）监测是否可以减少妊娠期和产后血压测量中的种族差异尚不清楚。这项研究评估了参加互联产妇在线监测（CMOM）计划的黑人和白人患者是否显示出BP确定和间隔时间的改善。方法：使用电子健康记录数据，将2016年1月至2022年9月期间纳入CMOM的3,976名孕妇患者的回顾性队列与匹配的常规护理患者进行比较。主要结果是妊娠和产后期间的BP确定（BP测量次数）和BP间隔（BP测量之间的时间）。还评估了妊娠高血压疾病患者在分娩后7天内检查BP的比例。结果：黑人患者的CMOM入学率低于白人患者（42.1％vs54.7％，P<0.0001)。CMOM组的患者在怀孕期间（比率=1.78，95％CI1.74-1.82）和产后期间（比率=1.30，95％CI1.23-1.37）的BP测量值高于常规护理组的患者，与常规治疗的患者相比，CMOM中的黑人和白人患者均有显着改善。CMOM干预并未使Black患者（风险比=1.03，95％CI0.94-1.11）和White患者（风险比=1.09，95％CI1.01-1.17）的产后7天依从性得到改善。结论：远程BP监测计划是提高所有患者产前和产后期间BP测量频率并缩短测量间隔的有用工具。需要进行未来的评估，以确定向黑人患者提供该计划和招募黑人患者的障碍。
