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Date and Duration: September 2020 – July 2022

Hypertension in Pregnancy Initiative

Purpose

Hypertensive disorders in pregnancy are a significant contributor to maternal morbidity and mortality in the United States, with 15.9% of all pregnancies impacted and nearly 32% of maternal deaths during delivery hospitalizations in 2019 associated with these conditions. This initiative will assess health system barriers, provide education to address provider knowledge gaps and treatment disparities, introduce standardized processes for hypertension treatment, incorporate antiracism practices, and enhance patient education and engagement.

Hypertension in Pregnancy and the Postpartum Period Initiative Charter
References

1. Ford ND, Cox S, Ko JY, Ouyang L, Romero L, Colarusso T, Ferre CD, Kroelinger CD, Hayes DK, Barfield WD. Hypertensive Disorders in Pregnancy and Mortality at Delivery Hospitalization – United States, 2017-MMWR Morb Mortal Wkly Rep. 2022;71:585-591. DOI: 10.15585/mmwr.mm7117a1.

2.Ford ND, Cox S, Ko JY, Ouyang L, Romero L, Colarusso T, Ferre CD, Kroelinger CD, Hayes DK, Barfield WD. Hypertensive Disorders in Pregnancy and Mortality at Delivery Hospitalization – United States, 2017-MMWR Morb Mortal Wkly Rep. 2022;71:585-591. DOI: 10.15585/mmwr.mm7117a1.

Goals & Objectives

1. Increase the percentage of those with severe hypertension treated within 60 minutes

2. Improve compliance of the HTN recognition tool and OB HTN emergency pathway

3. Improve discharge education

4. Increase the percentage of patients discharged with a blood pressure cuff

5. Increase the percentage of those patients with HTN who receive a blue band

6. Improve postpartum discharge follow up rates and time interval from discharge to follow-up visit

7. Reduce maternal morbidity and mortality resulting from obstetrical hypertension

Participating teams have increased the percentage of birthing individuals with severe hypertension who received treatment within 60 minutes from 55% to 71%.

How Success Is Tracked

A family of measures is a set of related metrics used in Quality Improvement (QI) initiatives to assess the overall impact, outcomes, and processes of a project. These measures provide a comprehensive picture of the initiative’s effectiveness and guide decision-making. A family of measures typically includes three types of metrics:

Outcome Measures

Definition: Metrics that reflect the ultimate goals or results of the initiative, focusing on the impact on patients, populations, or systems.
Example: Reduction in severe maternal morbidity rates or improvement in patient satisfaction scores.
Purpose: To evaluate whether the initiative achieved its desired results.

Process Measures

Definition: Metrics that assess whether specific actions or interventions were implemented as intended. These focus on the steps or processes involved in achieving the outcome.
Example: Percentage of patients treated for severe hypertension within 60 minutes or compliance with a standardized care pathway.
Purpose: To monitor the implementation and effectiveness of the processes driving the outcomes.

Balancing Measures

Definition: Metrics that ensure improvements in one area do not negatively affect other areas. They check for unintended consequences or trade-offs.
Example: Monitoring readmission rates or the burden of increased documentation on staff.
Purpose: To ensure that changes made to improve one outcome do not create new problems elsewhere.

Family Of Measures

1. Percent of patients with severe range Blood Pressure (BP) treated within 60 minutes

2. Percent compliance with OB hypertension emergency pathway from all hospital points of entry

3. Percent of patients with severe hypertension with discharge education

4. Percent of patients with severe HTN offered a blood pressure cuff at discharge

5. Percent of patients with severe HTN offered a blue band at discharge 6

6. Percent of patients with a hypertensive disorder of pregnancy scheduled for post discharge follow up appointments or home health care within 3-5 days

7. Severe maternal morbidity and mortality rates due to severe HTN

Toolkit

Our toolkits provide targeted resources specific to each QI program, offering essential materials to support healthcare teams in achieving improvement goals.

AIM Bundle- Severe Hypertension in Pregnancy
MDH- Ordering Blood Pressure Cuffs
Blue Band Provider & Patient Guide
AWHONN Post-Birth Warning Signs
Blue Band Booklet

Reports

MN Progress Report on Hypertension in Pregnancy and Postpartum Period Initiative

Download

MNPQC’s Quality Improvement Programs were developed with support and guidance from hospital teams and professional faculty throughout the state of Minnesota. The contents do not necessarily represent the official views of, nor an endorsement, by MNPQC or our partners.