Care-at-Home Technology Looks to Decrease Risks of Maternal Mortality
By Matt Phillion
According to the CDC, maternal death rates have soared to their highest peak in 60 years, and a new technology platform aims to reduce the risk of maternal mortality through home-based surveillance.
Current Health, a Best Buy Health company, is leveraging its care-at-home platform to quickly identify signs of potentially fatal conditions related to pregnancy, such as severe-range hypertension and preeclampsia. The intent is to decrease hospitalizations and reduce length of stay when admission is required, as well as to reduce the need for ambulatory visits during the immediate postpartum period and provide an overall better patient experience.
The solution wasn’t originally designed for maternal care. Rather, it was intended to help determine when best to readmit patients with chronic conditions. But as remote monitoring grew in uptake throughout the COVID-19 pandemic, the opportunity to use the platform with maternal patients presented itself.
In the maternity setting, Current Health has used the technology in the U.S., the U.K., and Uganda for various levels of monitoring, enabling caregivers to see issues through different lenses.
“My background is in critical care and remote care, [in] high mountains or remote places. When I came here, I thought building the technology was going to be the hardest part, but it turns out it’s just a piece of the puzzle,” says Matt Wilkes, MD, PhD, director of clinical affairs with Current Health. “What really matters is implementation: fitting it to provider workflows and really bringing patients through the experience.”
To illustrate this, Wilkes describes implementing Current Health’s platform in the U.K. in a trust called Norfolk and Norwich, located outside of London. There is a big gap between poorer communities (often populated by immigrants) and wealthier residents. “The two don’t meet, and health inequality there is startling,” says Wilkes. “During COVID, what they were discovering was that the healthcare staff’s ability to reach vulnerable immigrant mothers was reduced. Part of it was a cultural response, and part of it was the extra distance due to protective measures and the re-diversion of staff.”
A virtual ward was started to look after these mothers. “These mothers were triaged or given a continuous wearable and had regular appointments with virtual midwives,” says Wilkes. “[The midwives] could offer antenatal care for vulnerable or struggling patients to offer them better access.”
By reaching these patients in a nontraditional way, the results were significant. “Looking at clinical outcomes, they were three times less likely to need hospital readmission,” says Wilkes. “That was exciting. We reached those patients where they were, providing not just emergency care but routine care, and seeing those outcomes reflected in the acute antepartum period.”
The U.K. and U.S. see similar trends in the causes of maternal mortality, specifically maternal bleeding and cardiac issues. Meanwhile, during their work in Uganda, Current Health encountered issues like severe bleeding and infections.
“It’s the same problem but with a different flavor,” explains Wilkes. “Access to care, meeting the patient where they are, giving them confidence, giving them routine perinatal care. I’ve worked in the U.K., in Queens and the South Bronx, and I’ve worked in Africa, and I’ve seen common problems.”
If these issues are ubiquitous for mothers regardless of geography, where do we begin in fixing them? “It’s about finding those most vulnerable, and treating those patients most effective and in a way they’re most likely to adhere to,” says Wilkes. “How can we ensure we’re best prepared for whatever the acute care episode may be?”
Prompt treatment, effective follow-up, and tracking what you’ve been doing for the patient—they’re common threads for addressing issues faced by many new mothers.
A look at postpartum hypertension
On the U.S. side, Current Health has worked with the Defense Health Agency to look at postpartum hypertension. “We know this was a huge cause of maternal mortality and morbidity,” says Wilkes.
Women were given a remote orientation to the program and provided with a kit and a blood pressure cuff. They could participate in video visits (and receive additional services like visit reminders and language translation) using their smartphone, and were provided a tablet if they didn’t have a video-capable device.
The participation numbers were very successful, Wilkes notes. “We had 89% who enrolled transmitting their readings, and 86% adhered to their blood pressure monitoring for at least two weeks,” he says.
They also found that the program rated high in patient satisfaction. “What was interesting from our perspective was the time and travel saved for those new mothers, even excluding those who lived far away,” says Wilkes. “For those who lived within close proximity of their medical center, we saved 220 miles of travel per patient. That, in turn, freed up 2.3 to 3.5 in-person appointments per center.” This is important because inefficient scheduling and appointments contributes to provider burnout, he notes.
“We helped them triage, treat them at home, and free up clinical spots for those who needed in-person visits,” says Wilkes.
Meanwhile, patients were provided a technology that they could adhere to and that made sense, both in terms of how to use it and why they were using it.
It’s too early to know the impact on mortality rates, but the work is headed in the right direction. “We need more patients, but the fact that we’re monitoring and treating is encouraging,” says Wilkes. “As I said, at the beginning I thought the hard part was the technology, but actually to get this adopted and make a difference—to find something for the hospital system at the top level, something for the physicians and nurses at the provider level, and something for the patient—is the bigger part.”
Data in a better setting
Providers can find themselves swimming in patient data, so how that data is obtained and used can make a difference. By identifying the patients who will most benefit from this level of at-home tracking and monitoring, the technology can put more effective, actionable data in providers’ hands.
“More data isn’t always good, but data in a better setting makes a difference—it’s effectively triage,” says Wilkes.
Current Health assumed virtual visits couldn’t match in-person visits, but the team was surprised to find the opposite was true. “We were operating on the hypothesis that virtual would be worse, but we were surprised to see they built deeper relationships through virtual care,” says Wilkes. “The reason was they were seeing them in their home environment, seeing their kids and pets, and contextualizing their situation as a person and not a patient in a bed.”
The virtual visits helped ensure providers weren’t rushing between patients, letting them speak to a patient with their full focus. “They didn’t have alarms going off elsewhere,” says Wilkes. “I could see providers saying this was more efficient, but I was surprised to hear that they found this more fulfilling.”
Speaking of alarms, there is a balancing act for alerts when monitoring patients in the home. In the hospital, alarms are designed to be sensitive and to go off when something might be wrong. In the home, there needs to be more specificity.
“The activities of daily living can impact this,” says Wilkes. “If you’ve had a caesarean, going up the stairs is going to have an impact on your heart rate. We have to think incredibly carefully about alarms so they’re sensitive but specific and safe. Maternity is an interesting challenge in that regard.” But when done well, alarm management enables effective treatment of the patient at home, which helps keep physicians practicing at the top of their license.
What does the future look like for at-home monitoring in maternal care? “We have the ability to reach people in so many ways,” says Wilkes. “Virtual visits, logistics, social care centers, wearables, and we have a platform to draw it all together. What I want to see us do is look at patients across the whole care continuum.”
Being able to pick out the patients who will benefit from remote monitoring and leveraging the right technology for their needs can have a massive impact not just on those patients, but beyond.
“We were running a trial in a hospital in Uganda where there was very little monitoring, and it led to the development of an intranet infrastructure at that hospital,” says Wilkes. “Those are the incidental benefits that come from this bigger task. It’s those kinds of things that make a difference. Meeting patients where they are is at the heart of it, no more so than when they are young mothers with busy families.”
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.