Progress Through Symbiosis: The Bridges Clinic
Cardio-obstetrics multidisciplinary clinics emerged through the symbiotic expertise of cardiology and maternal fetal medicine (MFM) as a response to growing maternal mortality rates, among which more than half are of cardiac etiologies and occur following delivery. Among the most successful and rapidly expanding cardio-obstetrics centers is the Bridges Clinic at the Magee Women's Hospital, situated in Pittsburgh, Pennsylvania. Its creation is a labor of love of cardiologist Malamo Countouris, MD, and maternal fetal medicine physician, Alisse Hauspurg, MD. It features a multidisciplinary postpartum hypertension clinic implementing both virtual home monitoring as well as virtual visits. This ensures delivery of equitable care across diverse racial and socioeconomic groups and in different geographical settings.
What was your initial motivation behind starting the Bridges clinic?
Countouris: We saw a need to create a "medical home" for patients with hypertensive disorders of pregnancy in the postpartum period. We found that many women did not have a provider who could manage their hypertension beyond six weeks after delivery. Many did not have a primary care provider, or providers were uncomfortable managing postpartum hypertension. The Bridges clinic served as a "bridge" from typical postpartum obstetrics to longitudinal care with a primary care physician or cardiologist.
Hauspurg: Our collaboration has allowed for improved, effective hypertension care for this group of individuals who otherwise have much higher risks of significant morbidity and care utilization in the first few weeks postpartum.
What was the process by which you created the clinic? Any major logistical barriers?
Hauspurg: We met with key stakeholders across multiple disciplines, including obstetrics providers, pediatricians, family medicine and internal medicine to promote our clinic and discuss the importance of adequate control of hypertension following a pregnancy complicated by a hypertensive disorder of pregnancy. As we built the clinic, we found that there was a need for improved communication of blood pressure results with our team, which prompted us to create a remote blood pressure monitoring program that directly interfaces with the electronic medical record. We enroll patients in this through the first year postpartum. We have found that our relatively tech-savvy patients have been thrilled to have this option for monitoring and management and not having to type out blood pressures into a message to their provider or call the clinic to report blood pressures.
What is the setup and frequency of the clinic?
Countouris and Hauspurg: We currently see patients two afternoons a month and have expanded to a second satellite location. We are hoping to add an additional two afternoons per month over the next year. We have 10 patient slots per clinic session. Every patient is seen by both MFM and cardiology. After we see each patient, we debrief with each other on issues relating to our respective clinical disciplines.
What outcomes have come from the clinic?
Countouris and Hauspurg: We have an impressive > 80% show rate, which I think highlights that women value and have an ongoing need for this type of care. Having virtual visits has been very convenient for women in the postpartum period, particularly to allay fears about infection risk should they have to bring their newborn with them to an appointment.
What does the future hold?
Countouris and Hauspurg: Expansion, for sure! We're currently seeing only a minority of patients who have deliveries complicated by preeclampsia at Magee Womens Hospital. We are targeting those who are highest risk – specifically those with ongoing hypertension, need for antihypertensive medications beyond six weeks, those with heart failure in association with preeclampsia, and those with multiple cardiovascular risk factors. We will also be incorporating research initiatives for postpartum women seen in our clinic.
Since its creation in 2019, the Bridges clinic has successfully established a multidisciplinary medical home for postpartum high-risk cardiac patients. It has far surpassed national postpartum show rates, including women from some of the most vulnerable backgrounds. Its success has allowed for expansion to satellite sites, and we look forward to seeing longitundal outcomes curbing postpartum maternal morbidity and mortality.
This article was authored by Agnes Koczo, MD, an FIT at University of Pittsburgh Medical Center. Twitter: @AkoczoAgnes
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