Timely nudge via EMR may improve transition of care for CVD after pregnancy

An electronic reminder sent to a provider ahead of a postpartum visit increased discussions about transition of care and CVD risk between the provider and patients who had a hypertensive disorder of pregnancy, researchers reported.

“Scalable interventions are needed to improve preventive care for those with increased CVD risk identified during pregnancy,” Jourdan E. Triebwasser, MD, MA, and colleagues from the Perelman School of Medicine at the University of Pennsylvania, wrote in the American Journal of Obstetrics and Gynecology.

Triebwasser and colleagues conducted a randomized clinical trial of 222 women aged 18 years or older who had a hypertensive disorder of pregnancy. The participants were enrolled in the postpartum BP monitoring program Heart Safe Motherhood and had positive pressure ventilation 4 to 13 weeks after delivery.

The researchers randomly assigned the women in a 1:1 ratio to receive usual postpartum care or a “nudge” intervention between Feb. 8, 2021, and June 10, 2021. In the nudge group, the provider conducting the postpartum visit received a nudge through the patient’s electronic medical record a week prior to the visit. The nudge included counseling phrases and patient-specific information on hypertensive disorder of pregnancy and gestational diabetes. This information was also available through the EMR phrase manager for the usual care group. The researchers investigated how often providers accessed the nudges and whether they resulted in documentation of counseling on transitions of care to primary care or cardiology.

The mean age of the patients was 32.5 years in the usual care group and 32 years in the nudge group. In the usual care group, 58.5% of women were white, 32.2% were Black and 3.4% were Hispanic. Also, 16.1% had diabetes. In the nudge group, 55.8% were white, 32.7% were Black and 5.8% were Hispanic; 6.7% had diabetes.

Within 1 week of the nudges being sent, 100% had been accessed by the receiving provider, according to Triebwasser and colleagues. Women in the nudge group were significantly more likely to receive documented counseling on transitions of care (RR = 1.69; 95% CI 1.09-2.6), CVD risk (RR = 2.55; 95% CI 1.23- 5.3) and use of aspirin during a future pregnancy (RR = 7.66; 95% CI 1.79-32.82) from their provider. Specifically, 38.5% of the nudge group received counseling on transitions of care compared with 22.9% of the usual care group. Also, 21.9% of the nudge group received CVD counseling and 14.6% received counseling on future aspirin use compared with 8.6% and 1.9% of the usual care group. Overall, the researchers observed that the nudge group used counseling phrases more often than the usual care group (11.5% vs. 1.9%, P = .006).

“A timely nudge improved counseling about transitions of care and CVD risk after a hypertensive disorder of pregnancy,” Triebwasser and colleagues wrote. “The impact of the nudge on preventive care and health outcomes merits investigation.”