The Cuff Kit Program
Setting: Clinical Home
Topic Area: Access to Quality Healthcare Primary & Preventative Care Health Promotion & Communication
NPMs: NPM 1: Well-Woman Visit NPM 3: Risk-Appropriate Perinatal Care
As many as one in twelve pregnancies is affected by hypertension in its most dangerous form – preeclampsia. It is the second leading cause of maternal mortality worldwide and may lead to serious maternal complications, including stroke, eclampsia, and organ failure. Adverse perinatal outcomes for the fetus and newborn include intrauterine growth restriction, low birth weight, and stillbirth. Many of the complications associated with preeclampsia lead to early induction of labor or cesarean delivery and subsequent preterm birth.[USPSTF, JAMA, 2017] Further, it disproportionately affects black and native American women, both in prevalence and worse outcomes.[Johnson JD, 2020]] The COVID-19 crisis has affected prenatal and postpartum obstetrics care, rapidly moving in-person visits to telehealth, and often eliminating recommended one-week postpartum visits [Madden N, 2020]. This means that the recommended blood pressure (BP) and proteinuria assessments, and a review of signs and symptoms are hampered or missing for thousands of women each day [ACOG 2013, USPSTF 2018]. However, even post-pandemic experts anticipate an ongoing desire by both providers and patients to monitor blood pressure at home, particularly as the rate of preeclampsia and hypertensive disorders is rising. The purpose of The Cuff Kit Program is to enable accurate self-monitored blood pressure (SMBP) among pregnant and postpartum mothers at highest risk for hypertensive disorders of pregnancy and to ensure their blood pressure measurements are accessible to their healthcare providers for care management. The goal of this emerging practice is to improve self-efficacy among a vulnerable population by educating about the importance of blood pressure screening during and after pregnancy and by providing the tools to conduct these measurements at home, leading to improved health outcomes. The Cuff Kit includes a validated automatic blood pressure measuring device, specially created patient education materials about hypertension in pregnancy and how to accurately take your own blood pressure (print, video and online) in both English and Spanish, BP tracking logs, and a rubber “still at risk” bracelet for postpartum use, for distribution to patients via their healthcare providers. Participating healthcare providers include OB/GYNs in hospital and clinic settings, community health centers, Federally Qualified Health Centers, public health clinics, and nurse home-visiting programs. The key patient population for the Cuff Kit Program include those with individual risk factors (i.e., chronic hypertension, history of preeclampsia, obesity, age (35+), autoimmune disorders) and population-level risk factors (i.e., being Black American, Native American or living in a rural area) and who may not be able to purchase a device, either because of cost or availability.
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