Remote patient monitoring helped Chatney Russell’s care team keep tabs on her blood pressure — and ensure a safe pregnancy for her and her baby.
With 3 kids under the age of 13, Chatney Russell felt a range of emotions when she learned she was expecting her fourth: joy and excitement mixed with nervousness and worry.
“I have high blood pressure, so I knew this would be a high-risk pregnancy,” said Russell, 36, who works as the receiving lead in a warehouse in Conyers, Georgia.
High blood pressure during pregnancy can limit the baby’s growth or cause premature delivery. It also puts the mother at risk for problems including preeclampsia and stroke.
Russell had lost a pregnancy years earlier, so she worried about having a second miscarriage or giving birth prematurely. And as a single mom without easy access to transportation, she knew getting to prenatal appointments would be a challenge.
Russell was relieved to learn about an innovative telehealth program at Kaiser Permanente in Georgia designed to help monitor and control high blood pressure in pregnant women.
“They gave me a blood pressure cuff to use at home and taught me how to check my blood pressure twice a day and enter the results in an app on my phone,” she explained.
The readings were sent directly to Russell’s electronic health record, where any high readings triggered an alert for her care team. “The nurse would call and ask, ‘Do you have a headache? Are you dizzy?’ Sometimes she would ask me to come in to be seen so they could make changes to my medications.”
Women in the United States are much more likely to experience complications during pregnancy and childbirth that cause injury or death than women in other developed countries. That’s especially true for Black women, who are 2 to 3 times more likely to die from pregnancy-related causes than white women. While the causes of this disparity are complex, one factor is a higher prevalence of high blood pressure, or hypertension, among Black women.
At Kaiser Permanente in Georgia, 50% of maternity patients are Black, and 23% of maternity patients have or develop hypertension. That reality was the driving force behind the creation of the remote monitoring program for hypertension.
“We enrolled 736 women in the program in the first year, and we have already had 638 severe range alerts,” said Fatu Forna, MD, physician program director for perinatal safety and quality. “As a result of the alerts, we induced labor early in 36 women. Without that intervention, these women most likely would have had seizures, bleeding complications, or strokes. So we know that this program is working.”
One of those women was Chatney Russell. On January 19, 2020, 37 weeks into her pregnancy, she got a call from her nurse asking her to come in to be checked after recording a very high blood pressure.
“I had preeclampsia, which was dangerous for both me and the baby,” she said. “They tried to get my blood pressure down with medication, but it didn’t work, so they ended up inducing me.” Three hours later, she gave birth to a healthy boy she named Brayden.
Russell is grateful for the support she received from her care team. “I didn’t have insurance when my first 3 kids were born, and all of them ended up being born preterm,” she said. “The blood pressure program really helped keep me on track. Without it, things might not have worked out as well as they did.”
Georgia’s remote hypertension monitoring program is one of several virtual maternity care initiatives underway across Kaiser Permanente. While the programs benefit all mothers, they’re particularly important for women who struggle to get to prenatal appointments because they lack access to transportation, live far away, or can’t afford to take time off work or pay for transportation and child care when they go to the doctor.
Kaiser Permanente recently completed pilot studies in Oregon and Southern California to evaluate a blended perinatal care model that allows patients to have a portion of their prenatal appointments by video. Participants were given a blood pressure cuff, scale, and Doppler fetal monitor (used to detect the baby’s heartbeat), along with training in how to use the devices.
“In the past when we did a telehealth visit, we couldn’t check the mother’s blood pressure and weight or listen to the baby's heartbeat,” said Michael Fassett, MD, regional physician lead for perinatology at Kaiser Permanente in Southern California. “This program captures the integrity of a face-to-face prenatal visit.”