In partnership with multiple community agencies across the Triangle, the UNC Center for Women’s Health Research has received funding—approximately $2.5 million per year for five years—from the National Institutes of Health Heart, Lung, and Blood Institute (NHLBI) to identify effective strategies for implementing pregnancy-related hypertension best practices in the outpatient setting.
Aiming to reduce maternal morbidity and mortality, the Advancing Community and Clinical Care for Childbirth-related Hypertension: Implementation, Engagement and Valuing Equity (ACHIEVE) study engages health care, public health, and other community-based agencies and individuals in adapting the existing Alliance for Innovation on Maternal Safety Severe Hypertension During Pregnancy and Postpartum Period Safety Bundle to the outpatient, community setting.
The United States ranks at the bottom among high-income countries in maternal mortality and morbidity. In North Carolina, Black birthing people are two times more likely to die or experience serious complications related to pregnancy, with hypertension and cardiovascular disease (CVD) being the leading drivers of these outcomes and disparities. Pregnancy-related hypertension and CVD increase the risk of high blood pressure and CVD over the lifetime. Early recognition and appropriate treatment can save a mother’s life and promote long-term health.
Progress has been made in identifying best practices to identify and treat hypertension in pregnancy and postpartum; the challenge now is to implement and sustain best practices in the settings where those most impacted receive perinatal care, and to do so in partnership with patients, their families, and their communities.
This grant builds on work conducted over the last year to test the feasibility of a multicomponent strategy in three local clinics within the Piedmont Health Services network of community health centers. In Phase II, ACHIEVE will test the strategy across 20 outpatient clinics in the Triangle area that provide prenatal and postpartum care. Community-based organizations in the included counties will be funded to significantly expand guidance on adapting the “bundle” to various settings and developing information on the signs, symptoms, and treatment of hypertension in pregnancy and postpartum.
The leadership team includes Principal Investigator Kate Menard, MD, MPH, (UNC Obstetrics and Gynecology, Maternal Fetal Medicine) and an interdisciplinary group of Co-Investigators with expertise in implementation science, maternal/fetal medicine, family medicine, nursing, health equity, maternal and child health, and community engagement/community-based participatory research. This group includes: Alexandra Lightfoot, EdD, of UNC Gillings School of Global Public Health; Jennifer Leeman DrPH, MPH, MDiV, of the UNC School of Nursing; Narges Farahi, MD, from UNC Family Medicine and Piedmont Health Services; Nicole Teal, MD, MPH, of UNC-Chapel Hill Maternal-Fetal Medicine; Kimberly Harper, MSN, RN, MHA, of UNC Collaborative for Maternal and Infant Health; Jen Medearis Costello, MS, MPH, a leader of a Chatham birth equity coalition, Equity for Moms and Babies Realized Across Chatham (EMBRACe), and an adjunct instructor at UNC Gillings School of Global Public Health; and Sarahn Wheeler, MD, from Duke University’s Division of Maternal Fetal Medicine.
“Clinicians are trained in evidence-based medicine, but not how to translate these best practices to reality. As a family physician at a federally qualified heath center, I see this tension daily, given the complexity of patients’ lives and the impact of broader social and structural drivers of health. Because ACHIEVE was conceived in partnership with local community health center providers who live this reality and designed to integrate implementation science with equity-minded community engagement, this project has the potential to transform the way care is provided and will support equitable, respectful care for birthing people in our region,” said Dr. Farahi.
The ACHIEVE team includes a community coalition and patient action team to guide patient and community elements of the work, as well as teams of clinic champions. Kamara Barnett, a civic leader in Caswell County and patient of one of the pilot clinics, served as a patient advisor in Phase I and will lead the patient action team in Phase II. In her letter of support for this next phase of work, she wrote, “Being a part of this project has been very meaningful for me, my family, and my community, and I am hopeful about what our work will do to improve the perinatal care and birth outcomes for women like me.”
Co-I Leeman noted, “I am delighted to be partnering with this exceptional team of researchers, healthcare providers, and community members in their effort to improve North Carolina’s maternal health outcomes. In the first year of funding, the team developed a plan for implementing improvements in a way that fit the needs of both pregnant women and clinic providers and staff. As an implementation scientist, I look forward to studying clinics’ success implementing those improvements and the impact those improvements have on early detection and response to severe hypertension.”
Over the next five years, the study will expand from its current work in Caswell and Chatham counties to Orange, Alamance, Durham, and Wake counties. Piedmont Health Services, the primary clinical partner in Phase I, will be joined by public health department clinics and other Duke, UNC-Chapel Hill, and community-based clinics to adapt hypertension protocols and patient education materials and methods, then test then through simulation and observation in practice.
PI Dr. Menard added, “I consider it a great privilege to have the opportunity to work alongside this highly capable and committed team of academic and community partners in the development of such a meaningful project. This is a remarkable opportunity to dig so deeply into what truly works in the outpatient setting, with a laser focus on community engagement, respectful care, equity. It is not enough to know what medicines work for treatment of pregnancy related hypertension. This study will help us to understand the best strategies to implement acceptable and sustainable lifesaving care plans. We cannot wait to get started.”