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

Background: Guidelines recommend 3-day follow-up for severe hypertensive disorders of pregnancy (HDP) and 7–10 day follow-up for non-severe HDP, but implementation varies. Objective: 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 non-severe HDP. Study Design: 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. Results: Cohorts were similar at baseline. After implementation, all patients with severe HDP continued to receive 3-day follow-up instructions. Among patients with non-severe 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. Conclusions: The tool improved guideline-aligned provider recommendations for postpartum HDP. Scheduling changes were limited, suggesting future efforts should target workflow and system processes..