Exploring associations between nasal fluid inflammatory proteins and patient-reported symptom burden in respiratory disease.

Hypertensive disorders of pregnancy (HDP) impact up to one in seven birthing people [] and continue to be a leading cause of severe maternal morbidity and mortality [, , , , , , , , , , , ]. With blood pressures (BPs) typically peaking 3–6 days after delivery, the post‐discharge period represents a particularly high‐risk time for severe hypertension and worsening disease []. Untreated severe hypertension can lead to maternal stroke, seizure, end‐organ damage, and death [, ]. Previous studies have demonstrated that postpartum remote patient monitoring programs can improve patient safety outcomes, cost‐effectiveness, patient satisfaction, and health care autonomy [, , , , , , , , , , , , , , , ]. Given their robust clinical benefits, remote BP monitoring (RBPM) programs have become widely adopted. Existing studies, however, have largely focused on closed‐ended survey data that provide limited insight into the patient's lived experience with home BP monitoring, and the nuances that drive adherence and engagement in these programs [, , , , ]. Additionally, previous RBPM program publications utilize stand‐alone mobile applications or third‐party vendor platforms that can be costly and operate outside of or parallel to the electronic health record (EHR). As we evaluated our own RPBM program, Home Observation of Postpartum Elevated Blood Pressure (HOPE‐BP), which was designed and built directly into our EHR to create a cost‐saving, seamless patient and provider experience, we sought to more fully capture the patient perspective and to illuminate participant facilitators and challenges. By centering patient voices, this study aims to complement existing clinical evidence and inform more patient‐centered, equitable models for postpartum hypertension care, and may be particularly useful to programs seeking to implement a low‐cost alternative to third‐party RBPM programs directly within their EHR. HOPE‐BP is a postpartum RBPM program, developed internally at our academic medical center, for all English‐speaking birthing patients diagnosed with HDP prior to or during their delivery admission. Patients are enrolled at the time of hospital discharge and then prompted to enter BPs twice daily through 6 weeks postpartum. The HOPE‐BP program was customly designed within the patient portal of our hospital's EHR (Epic's MyChart Care Companion), allowing for seamless integration for both patients and the clinical care team. HOPE‐BP was designed to provide active feedback to participating patients on what their BP values mean, as well as guidance for appropriate next steps based on their entered values (Figure ). There are two windows of time in which patients receive prompts through their portal, once between 8:00 a.m. and 12:00 p.m., and again between 12:00 p.m. and 4:00 p.m. Patients receive customized feedback based on whether their entered BP is low, normal, elevated, or severely elevated. These messages include a symptom assessment, when indicated, and recommendations for next steps in care, which have been tailored to different messaging based on whether a BP has been entered during business hours versus after‐hours. BP entries flow into the EHR automatically and specific BP escalations are flagged for review during business hours by the HOPE‐BP nursing team. After hours and on weekends, patients receive instructions to call the on‐call provider for severe hypertension (systolic BP [SBP] ≥ 160 and/or diastolic BP [DBP] ≥ 110 mmHg) or symptoms that may indicate worsening disease. HOPE‐BP is a registered nurse (RN)‐driven monitoring program. The HOPE‐BP RN team monitors BPs and addresses escalations daily (M–F 8:00 a.m.–5:00 p.m.). Utilizing a standardized BP management protocol in combination with a nursing standing order, BP medications can be initiated and titrated to optimize BP control throughout program participation. Active communication with participating patients also helps identify patients at risk and in need of immediate hospital evaluation quickly. At completion of the program, patients and their referring providers receive a summary letter and recommendations for evidence‐based optimal management for ongoing care after an HDP.