Maternal mortality solutions: Remote blood pressure monitoring for pregnant and postpartum patients

. 9 MIN READ

AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.

Why is maternal mortality so high in the U.S.? How do you treat pregnancy-induced hypertension? How at-home blood pressure readings can reduce maternal mortality.

Our guest is Veronica Gillispie-Bell, MD, head of women's services at Ochsner Medical Center-Kenner. Dr. Gillispie-Bell also discusses proposed legislation to increase access to remote monitoring tools for pregnant patients and why this federal support is so important. AMA Chief Experience Officer Todd Unger hosts.

Speaker

  • Veronica Gillispie-Bell, MD, head of women's services, Ochsner Medical Center-Kenner

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Unger: Hello, and welcome to the AMA Update video and podcast. Today, we're talking about how remote patient monitoring can help treat the maternal health crisis in the U.S. My guest today is Dr. Veronica Gillispie-Bell, head of women's services at Ochsner Medical Center Kenner in Kenner, Louisiana. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Gillispie-Bell, welcome.

Dr. Gillispie-Bell: Thank you for having me.

Unger: Well over the last year, we have reported on a range of maternal health challenges that patients are facing in far too many ways. We're not headed in the right direction. So for starters, can you give us a brief overview of the maternal health crisis that we're seeing here in the U.S.?

Dr. Gillispie-Bell: Yes, Todd. It's really sad. You know that in the United States we have the worst maternal outcomes of any other high-income country. And these outcomes are actually getting worse. We've seen the maternal mortality rate increase year over year, really, for the last 30 years.

And I think what is most shocking, and one of the reasons that I do what I do, we see disparities in those outcomes. We see three Black women die at a rate of every one white woman and two Native American, American Indian women die at a rate of every one white woman. So it's a problem that we need to find a solution for.

Unger: So very high rates, not getting better, huge health disparities that we're seeing. So these are big challenges. It's going to take a lot of work to address all of those issues that you outlined. And every bit helps. Recently, you've been seeing improved outcomes among your pregnant patients thanks to a unique program at Ochsner called Connected MOM. Want to learn more about this. Tell us about the program.

Dr. Gillispie-Bell: Yes. So Connected MOM is a great program where we provide patients with a Bluetooth-enabled blood pressure cuff. And they're able to take those vital signs in the comfort of their own home. And it uploads to their electronic health records through their Bluetooth-enabled phone.  

With this, we have the option of also doing virtual visits for our patients. And so we've seen a lot of cases where moms are not able to come into care, either because of illness or because of, unfortunately, in Louisiana we have hurricanes, but things that would normally disrupt our care that allows us to stay connected to our patients. And because they're able to take their blood pressures, we're actually able to monitor one of those leading causes of severe maternal morbidity and mortality in the United States, which is hypertensive disorders of pregnancy.

Unger: Well, that's fantastic. We're tracking so many other things with our phones and Bluetooth devices. This sounds like a very, very worthwhile endeavor. I'm curious about results. What have you seen so far with Connected MOM?

Dr. Gillispie-Bell: Yes, we've seen a lot. We've seen earlier diagnoses of hypertensive disorders of pregnancy. We've even seen what's called masked hypertension, where patients may have a normal blood pressure in the clinic, but when they go home and take their blood pressure, it's elevated. We've been seeing cases where we've diagnosed preeclampsia earlier.

And then in the postpartum period, which is actually the part of pregnancy where patients are at the most, highest risk of having a mortality from this, we've seen an increase in taking blood pressures in the postpartum period so that we can make sure they're controlled.

Unger: Well, those are great results. And with results like that clearly we need more patients have access to a program like this. And in fact, there's a bill in Congress that aims to make that a reality. It's called the Connected Maternal Online Monitoring Act, or the MOM Act. And it's modeled after your program. Tell us about the goals of this particular bill.

Dr. Gillispie-Bell: Yes. I had the pleasure of doing congressional briefings with one of the bill sponsors, Senator Bill Cassidy of Louisiana. And one of the things that we’re asking for in the bill is funding.

We're asking for CMS to make sure that not just the moms that go to Ochsner, but all moms across the United States are aware of Bluetooth-enabled blood pressure devices and remote patient monitoring devices such as Connected MOM, that they are aware of it and that providers are aware of the funding for these devices as well as reimbursement.

Because while this is a product that helps our patients, it does take time to review the blood pressures, to review those vital signs, to then communicate with the patients. And so we're looking to make sure that providers are reimbursed for the time that it takes to do that extra care.

Unger: Well, the good news is the bill's got bipartisan support and the AMA is behind it. It's voiced its support as well. However, despite that, after being referred to the Committee on Finance in 2021, there hasn't been an update since. Why do you think having the backing of federal legislation like this is so important in addressing the maternal health crisis? And what do we do from here?

Dr. Gillispie-Bell: It is very important that we have that federal support. As we've mentioned, we have outcomes that are getting worse. And we talked about the disparities for our Black moms and for our other moms. What we didn't talk about is the rural moms and also having a disparity there. We know that those are areas that are under resourced.

And if we're really looking to bring resources to those individuals, to those patients that need it the most, we have to have federal support. We have a program that has shown to improve maternal outcomes. It is innovative. And in 2024, we have to think about different ways to deliver care. And it's not fair that only the patients that we serve are able to have access to this support, to this system, and to this care. And our funding it internally is not sustainable. And so we must have that support of federal funding to make this accessible for our patients and for patients across the United States.

Unger: Well, this kind of remote patient monitoring movement, and it's such an important space in maternal health. It's right in the arena that we're operating at the AMA, which is all about ensuring that technology is an asset to physicians and patients and not a burden. So we're very excited about that.

And in addition to advocating for the bill and supporting it at the federal level, what else can physicians and organized medicine do to broaden access to this potentially life-saving technology?

Dr. Gillispie-Bell: Yes. I think it's important for physicians to want to use the technology. It's great that we see that outcome for the patients. But again, we have to make sure that it is something that's workable and feasible for physicians as well. I think that each of us has that power to advocate for our patients in our institutions for having technology such as this and then to familiarize ourselves.

I think as physicians, I know going into medicine, I did not know that I was going to engage with technology as much as I am. But it's been important for me to be open and understand that there are different ways of delivering care. And again, I've seen the benefit. And so I think as physicians, we have to embrace the technology even though it may not be the way that we were trained.

Unger: Well, Dr. Gillispie-Bell, thank you so much for joining us today. And just a huge shout out to you and the folks at Ochsner for trailblazing on such an important program. Again, if you are interested in how we can make technology work for physicians and not the other way around, that's exactly the kind of issues that the AMA is working on. And so I encourage you to support that initiative and more programming like this by becoming an AMA member at ama-assn.org/join.

That wraps up today's episode. We'll be back soon with another AMA Update. Be sure to subscribe for new episodes. And you can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.


Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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