An Enhanced Community Health Worker Support Program for Postpartum women with Hypertensive Disorders of Pregnancy at Grady Memorial Hospital, Atlanta, GA: Baseline Survey Results and Preliminary Findings Open Access

Dansou, Alda (Spring 2023)

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Background: Women with Hypertensive Disorders of Pregnancy (HDP) are at greater short and long-term risk for developing cardiovascular diseases. Although there is emerging research investigating management of HDP throughout postpartum, there is a lack of exploration of Community Health Worker (CHW) models that can help reduce HDP burden and bridge disparities for minority populations. This study aims to evaluate the associations between social determinants of health and HDP, as well as to contribute preliminary findings towards the feasibility of utilizing CHWs in helping to manage the burden of HDP.

Methods: 30 participants were enrolled in the first phase of an enhanced CHW demonstration project taking place at Grady Memorial Hospital in Atlanta, GA. As part of the project, all 30 participants were given a blood pressure device to self-measure blood pressure (SMBP). Medical chart reviews were conducted on all 30 participants for demographic and obstetric history, and 25 participants took a baseline survey. Descriptive statistics were used to summarize baseline and Epic data. Change in Blood pressure was calculated using a paired t-test comparing averaged enrollment readings to 6-week follow-up, ± 2 weeks. ANOVA and linear regressions were used to test for associations between Blood pressure and sample characteristics.

Results: Overall 53.3% of participants are Black or African American and 46.7% are Hispanic or Latino. There is significant difference between blood pressure at enrollment and at 6-week follow-up ± 2 weeks (p=0.0029). The t-test revealed a mean difference of 13.13 ± 15.33 mmHg of systolic blood pressure and 8.1 ± 6.9 mmHg for diastolic blood pressure. Furthermore, participant’s decreased no-show rate of 28%, relative to Grady’s approximate 70% is a main unintended result from this program.

Conclusions: Overall, this study has provided preliminary evidence for the efficacy of utilizing CHWs to help bridge healthcare gaps. As there are various limits to non-randomized studies, we call for heightened prioritization and investigation of postpartum HDP interventions that center the use of CHWs, SMBP, and lifestyle education, especially randomized controlled trials that center minority populations. 

Table of Contents

Table of Contents

Chapter I: Introduction 1

Chapter II: Literature Review 2

I. Introduction 2

II. Existing Models & Interventions 5

III. Project Background 10

Chapter III: Methods 12

Study Design: 12

Study Setting: 12

Participants: 12

Intervention: 12

Materials & Resources:13

Evaluation & Data Collection: 14

Analysis: 16

Chapter IV: Results 17

EPIC Medical Chart Review: 17

Baseline Survey Results 18

Primary Outcome: Blood Pressure 21

Secondary Outcome: Postpartum Check-up No-Show Rate 22

Chapter V: Discussion 22

Appendix I: Data Visualization 30

Appendix I: Postpartum Dietary Management CHW Training Curriculum 65

Appendix II: Patient Education Booklet, “High Blood Pressure: A Mother’s Survival Guide”

Appendix III: Baseline Survey (Version English)

GRADY Community Health Worker Support for Hypertension in Pregnancy Demonstration Project

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