# Risk Stratification of Postpartum Patients with Hypertensive Disorders of Pregnancy to Telehealth Follow-Up: A Quality Improvement Project

## TL;DR

A risk stratification tool helped providers follow guidelines for postpartum follow-up of hypertensive disorders, reducing unnecessary 3-day checkups for nonsevere cases.

## Contribution

A new risk stratification tool was developed and implemented to align provider recommendations with postpartum follow-up guidelines for hypertensive disorders.

## Key findings

- Among nonsevere HDP patients, 3-day follow-up recommendations dropped from 100% to 31.1% after tool implementation.
- Severe HDP patients consistently received 3-day follow-up instructions, as recommended by guidelines.
- Scheduling for telehealth follow-up decreased for nonsevere HDP but did not improve for severe HDP.

## Abstract

Guidelines recommend a 3-day follow-up for severe hypertensive disorders of pregnancy (HDP) and a 7- to 10-day follow-up for nonsevere HDP, but implementation varies.

To improve adherence to guideline-recommended postpartum follow-up by targeting provider discharge recommendations. A risk stratification tool incorporating HDP severity, maternal symptoms, and discharge blood pressure guided providers to recommend telehealth follow-up at 3, 5, or 7 days. We aimed to maintain 3-day recommendations for severe HDP and reduce unnecessary 3-day recommendations for nonsevere HDP.

This quality improvement project was conducted at a single urban academic institution. The risk stratification tool was integrated into discharge workflows, and demographic, clinical, and telehealth follow-up data for pre- and post-intervention cohorts were abstracted from the electronic medical record and compared using summary statistics and bivariate analyses.

Cohorts were similar at baseline. After implementation, all patients with severe HDP continued to receive 3-day follow-up instructions. Among patients with nonsevere HDP patients, 3-day recommendations decreased from 100 to 31.1% (
p
 < 0.001), with a corresponding decrease in 3-day telehealth scheduling. Scheduling for severe HDP did not improve.

The tool improved guideline-aligned provider recommendations for postpartum HDP. Scheduling changes were limited, suggesting future efforts should target workflow and system processes.