Intermountain Health has developed an innovative clinical care process model that brings together providers in women’s health and primary care with pharmacists and experts in cardiovascular medicine and nephrology (kidney care) to proactively identify, manage, and monitor patients at risk for complications of hypertension during and after pregnancy.

The Pregnancy and Hypertension Care Process Model aims to help patients modify their risk factors for hypertension and reduce its occurrence and progression to more serious hypertensive disorders of pregnancy including preeclampsia (toxemia), and eclampsia, and reduce their risk for serious heart conditions, such as heart attacks, strokes, and heart failure later in life.

“With this team-based approach of practicing care, we’re connecting the gap between caring for patients during and after pregnancy by guiding and ensuring continuity of care after delivery,” said Dr. Donna Dizon-Townson, a maternal-fetal medicine physician leading this work at Intermountain Health in Provo, Utah.

In the United States, up to 4 in 10 women will have long-term high blood pressure after giving birth. Hypertension, or high blood pressure, is often called a silent killer because people usually do not have any symptoms until damage to organs has occurred.

Hypertensive disorders of pregnancy affect up to 20 percent of all pregnancies. Hypertension is also a disease marker for other potential health complications.

Hypertension during pregnancy and the related more serious disorders it can progress to if untreated, such as preeclampsia (toxemia) and eclampsia, are leading drivers of serious maternal health conditions, post-partum readmissions to the hospital, and long-term cardiovascular risk in women. Those cardiovascular risks can lead to serious conditions like heart attacks, strokes, and heart failure.

“Pregnant patients are often quite motivated to seek care and stay healthy during pregnancy to help their baby’s development. For many reasons after delivery, some patients are at risk of not receiving follow-up care. Optimal management of blood pressure after pregnancy is just as important as well-controlled blood pressure during pregnancy,” Dr. Dizon-Townson added.

Management of blood pressure during pregnancy can minimize the risk for adverse pregnancy outcomes including preterm birth, and optimal management of blood pressure after pregnancy can minimize maternal cardiovascular risks including heart attacks, heart failure, stroke, and even death.

Intermountain’s new and unique Pregnancy and Hypertension Care Process Model emphasizes whole-person continuous care. It gives women’s health and primary care providers and their prenatal and postpartum patients the tools and education they need to proactively manage hypertension conditions, including coordinating patient care and knowing when to refer to other medical specialists in cardiology and nephrology.

Cardiologists are specially trained to care for heart conditions. Having preeclampsia or eclampsia can also affect kidney health, which may require care from a nephrologist.

“Collaborating with so many providers across Intermountain with one specific goal in mind created an opportunity for us to have a real impact on women’s health,” said Kirstin Hesterberg, DO, an Intermountain Health physician in Denver, who specializes in women’s cardiovascular disease and pregnancy and is closely involved in this work. “We’re excited to track this new care pathway and see the positive outcomes.” 

“We hope that patients with hypertension during and after pregnancy are identified and get appropriate care, follow-up, and referrals, and receive specific education about their condition,” said Kismet Rasmusson, NP, cardiology program development director at Intermountain Health in Salt Lake City and an advance practice provider in heart failure and transplant at Intermountain Medical Center in Murray, Utah.

“Ultimately, if we treat cardiovascular risks prior to pregnancy, we hope to see fewer cases of hypertensive conditions during pregnancy,” she added.

The goal of Intermountain’s Pregnancy and Hypertension Care Process Model is to reduce the occurrence and progression of hypertensive disorders of pregnancy. 

Key components include:

• Evidence-based pathways for the screening and management of chronic and gestational hypertension.
• Guidance on postpartum follow-up and transition to primary care, cardiology, and/or nephrology.
• Integrated strategies to educate and help patients modify their hypertension risk factors, live a healthy lifestyle, and if needed, use appropriate medication safely during pregnancy and breastfeeding.
• Tools to facilitate collaborative care across multiple medical specialties and to screen for cardiovascular disease and related kidney conditions.

“In the past, there’s been a perception that if you have preeclampsia and deliver your baby, you’re cured. But in reality, the diagnosis of gestational hypertension or preeclampsia serves as a disease marker for other cardiovascular complications that can occur after delivery. Maintaining your blood pressure not only during pregnancy, but also after and in between pregnancies is important for women,” said Dr. Dizon-Townson.

The new care model is standardizing follow-up with postpartum patients with hypertension disorders before they leave the hospital following childbirth and outside of the hospital. Their blood pressure is checked within 72 hours after birth through remote monitoring, and again 7-10 days after they are discharged from the hospital to help identify early issues.

It will also be monitored again at their postpartum clinic visit, which is recommended at 4-6 weeks postpartum. Long-term follow-up visits for patients with hypertension are recommended at various intervals after that until one year postpartum to help identify and address cardiovascular risks such as diabetes, obesity, and high cholesterol.

Dr. Dizon-Townson also emphasized the importance of pre-pregnancy and prenatal visits so patients can have their blood pressure monitored and know if they need to make any lifestyle or medication changes before or during pregnancy.

“Research shows that after childbirth and during the postpartum period we need to continue blood pressure surveillance. Many insurance companies are now covering remote blood pressure monitoring equipment that can be used at home,” said Dr. Dizon-Townson.

“As we were creating our care process model, the American College of Cardiology published a Postpartum Hypertension Clinic Development Toolkit. We used this as a resource for best patient practice for follow up and management of women who had a pregnancy complicated by a hypertensive condition. When we took our care process model and compared it with their toolkit, we found a lot of similarities and overlap between the two publications. This was exciting and served as a validation of our care process model,” she added.

According to Dr. Dizon-Townson, it’s important for moms to have their blood pressure tracked and checked frequently during and after pregnancy to avoid serious health problems. Urine tests also help monitor for protein in the urine which can be associated with high blood pressure.

“We can teach patients how to safely monitor their blood pressure at home, and we can remotely monitor it. This results in fewer postpartum hospital visits, hospital readmissions and better adherence to blood pressure medications,” said Dr. Dizon-Townson.
 
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Intermountain Health is now offering pre-pregnancy, prenatal, and postpartum maternal health services in the Evanston, Wyoming, area through a new program called Maternal Health Connection (MHC). 

The new Intermountain program offers a combination of in-person, virtual and home visits, as well as remote patient monitoring for moms-to-be and new moms.

This community-based program provides access to virtual visits from Intermountain OB-GYN physicians and providers based in Utah. In-person care is provided by an Intermountain Health registered nurse at the MHC clinic, which is located in the Uinta Medical Building at 196 Arrowhead Drive. 

Clinic appointments are available two days per week on Wednesdays and Fridays, except for the first week of the month, it’s Monday and Friday.

“Pregnancy can be a difficult time in a woman's life, and current economic and geographic challenges do not make it simpler,” said Ibrahim Hammad, MD, a maternal fetal medicine physician at Intermountain Health who oversees the program.

“It's part of our responsibility as healthcare professionals, to not only provide care and treatment in clinics and hospitals, but also to reach out to our patients in an effort to ease their burden. This program is designed to bring maternal care to the patient,” he added.

Following the recent closure of Evanston Regional Hospital’s maternity services, pregnant and new moms have had to travel longer distances on remote roads, subject to severe weather, to access the frequent prenatal visits and follow-up postpartum care recommended to ensure a healthy pregnancy and recovery after childbirth.

“Our mission is to improve maternal and neonatal outcomes in Uinta County and surrounding communities. We’re excited to bring a local maternity care option to these Wyoming families,” said Krystal Richards, grants project director for Maternal Health Connections at Intermountain Health.

A large TV screen in the MHC clinic allows an OB-GYN physician or midwife based in Utah to consult with a Wyoming patient through telehealth, assisted by an Intermountain on-site nurse. 

Courtney Bettinson, BSN, provides the hands-on care needed during telehealth visits held at the clinic, such as taking moms’ vital signs and listening for baby’s heart tones. She also helps patients navigate referrals for any related care. She’s also able to do basic ultrasounds on-site.

“I’ve been a women and newborn nurse in Evanston for 13 years and have lived here all my life. I’ve put my heart and soul into developing this new program,” said Bettinson. “I’m passionate about women’s health and providing access to care for moms and babies. I love and care about the people in our community."

The MHC program also offers remote patient monitoring devices for participating pregnant moms to take home beginning at 28 weeks. The equipment includes a blood pressure cuff to determine current blood pressure; a pulse oximeter that measures oxygen saturation and heart rate; a thermometer to take body temperature, and a scale to measure the patient’s weight.

The monitoring equipment is connected to a mobile phone App that is connected to Intermountain Health’s Virtual Hospital in Murray, Utah. The virtual hospital is staffed 24 hours a day, seven days a week, by nurses who can elevate concerns or complications to an on-call maternal fetal medicine physician.

 Moms in the clinic can keep the equipment through six weeks postpartum.

Labor and delivery services for MHC patients are provided at nearby Intermountain Health hospitals, including Intermountain Health Park City Hospital in Park City, Utah and Intermountain Health McKay Dee Hospital in Ogden, Utah.

After moms and newborns return to Wyoming, Bettinson also does postpartum home visits, patient education, offers lactation support and does weight checks for babies. The MHC program provides home visits and related care for up to one year postpartum.

“This innovative maternity care access model is made possible by a $3.9 million grant awarded to Intermountain Health by the federal Health Resources and Services Administration,” said Richards. “Intermountain Health is committed to maintaining maternal healthcare access in Uinta County.”

Intermountain has offered Maternal Health Connections services in rural Montana since 2023. Results show significant travel mileage savings for patients, decreases in Edinburgh Postnatal Depression Scale scores, and an increase in continuity of care.

For more information on Intermountain Health’s Maternal Health Connection in Wyoming, call or text 307-426-0694 or send an email to mhcwy@imail.org

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Intermountain Health ahora ofrece servicios de salud materna para antes del embarazo, cuidado prenatal y posparto en el área de Evanston, Wyoming, a través de un programa llamado Maternal Health Connections (MHC, por sus siglas en inglés). El nuevo programa ofrece una combinación de consultas presenciales, virtuales y a domicilio, así como seguimiento del paciente a distancia en el caso de madres primerizas.

Este programa basado en la comunidad provee acceso a consultas virtuales con médicos y profesionales de la salud ginecológica basados en Utah. La atención médica en persona es brindado por una enfermera licenciada de Intermountain Health en la cínica MHC, ubicada en Uinta Medical Building en 196 Arrowhead Drive. Las citas en la clínica están disponibles dos veces a la semana, los miércoles y viernes, excepto la primera semana del mes, en la cual son el lunes y el viernes.

“El embarazo puede ser un momento difícil en la vida de la mujer, y los desafíos económicos y geográficos actuales no lo hacen más fácil”, dijo Ibrahim Hammad, MD, un médico de salud materno-fetal de Intermountain Health encargado del programa.

“Parte de nuestra responsabilidad como profesionales de atención médica, no solo es proveer el cuidado y tratamiento en clínicas y hospitales, sino también estar atentos a nuestras pacientes para aligerar su carga. Este programa está diseñado para proporcionar cuidados de maternidad a la paciente”.

Después del reciente cierre de los servicios de maternidad del Evanston Regional Hospital, las mujeres embarazadas y las que acaban de ser madres han tenido que viajar distancias más largas en carreteras remotas, lidiando con clima adverso, para tener acceso a consultas prenatales frecuentes y atención posparto recomendada para garantizar un embarazo y recuperación después del parto saludables.

“Nuestra misión es mejorar los resultados en las áreas de maternidad y neonatales en el condado de Uinta y las comunidades de alrededor. Nos complace ofrecer una opción de cuidado de maternidad a estas familias de Wyoming”, dijo Krystal Richards, la directora del proyecto de subvenciones para Maternal Health Connections en Intermountain Health.

Una pantalla de televisión grande en las clínicas MHC permite que el ginecólogo o la partera ubicados en Utah puedan tener una consulta con una paciente en Wyoming a través de Telehealth, con la ayuda de una enfermera de Intermountain en la clínica. Courtney Bettingson, BSN, proporciona el cuidado en persona necesario durante las consultas de Telehealth que tienen lugar en la clínica, tal como tomar los signos vitales de las madres y escuchar los latidos del corazón del bebé. Ella también ayuda a las pacientes a navegar el proceso de remisiones para cualquier tipo de atención médica relacionada. Ella también puede realizar ecografías básicas en la clínica.

“Durante 13 años, he sido enfermera de mujeres y recién nacidos en Evanston y he vivido aquí toda mi vida. He puesto mi corazón y alma en desarrollar este nuevo programa”, dijo Bettinson. “Mi pasión es la salud de la mujer y proveer el acceso a la atención médica a las madres y los bebés. Amo a las personas de nuestra comunidad y me preocupo por ellos”, añadió.

El programa de MHC también ofrece dispositivos de seguimiento a distancia para pacientes para que las madres embarazadas participantes se lleven a sus casas, empezando a las 28 semanas. El equipo incluye un tensiómetro para determinar la presión arterial actual; un oxímetro de pulso, el cual mide la saturación de oxígeno y el ritmo cardíaco; un termómetro para tomar la temperatura corporal y una balanza para tomar el peso de la paciente.

El equipo de seguimiento está conectado a una aplicación de teléfono móvil, la cual está conectada al hospital virtual de Intermountain en Murray, Utah. El hospital virtual tiene enfermeras disponibles 24 horas al día, siete días a la semana, quienes pueden derivar cualquier inquietud o complicación a un médico de medicina materno-fetal de guardia. Las madres se quedan con el equipo durante seis semanas después de dar a luz.

Hospitales de Intermountain Health cercanos, proveen los servicios de parto de pacientes de MHC, incluyendo Health Park City Hospital en Park City, Utah e Intermountain Health McKay Dee Hospital en Ogden, Utah.

Después, las madres y los recién nacidos vuelven a Wyoming, donde Bettinson también hace visitas posparto a domicilio, ofrece apoyo a la lactancia y comprueba el peso de los bebés. El programa de MHC provee visitas a domicilio y cuidados relacionados hasta un año después de dar a luz.

“Este modelo de acceso a atención materna innovador, se ha hecho posible gracias a una subvención de 3.9 millones de dólares otorgado a Intermountain Health por el departamento federal de Health Resources and Services Administration”, dijo Richards. “Intermountain Health está comprometido a mantener el acceso a cuidados médicos maternos en el condado de Uinta”.

Intermountain ha ofrecido servicios de Maternal Health Connections en las zonas rurales de Montana desde 2023. Los resultados muestran ahorros de transporte significativos para las pacientes, puntuaciones más bajas en la escala de depresión posparto Edinburgh y un aumento en la continuidad de la atención médica.

Para más información en cuanto a Maternal Health Connection de Intermountain Health, llame o mande un mensaje de texto al 307-426-0694, o mande un correo electrónico a mhcwy@imail.org