November 14, 2022
In partnership with multiple community agencies across the Triangle, the UNC-Chapel Hill Center for Women’s Health Research has received funding — approximately $2.5 million per year for five years — from the National Heart, Lung, and Blood Institute to identify 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 currently ranks at the bottom among high-income countries for rates of 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 disparate outcomes. Pregnancy-related hypertension and CVD increas the risk of high blood pressure and CVD over the lifetime, but early recognition and appropriate treatment can save a mother’s life and promote long-term health.
Researchers have already pinpointed best practices to identify and treat hypertension in pregnancy and postpartum. The challenge now is to implement and sustain those best practices in the settings where the people who are most affected receive their perinatal care — and to do so in partnership with patients, their families and their communities.
This grant builds on work conducted over the past year that tested the feasibility of a multicomponent strategy in three local clinics within the Piedmont Health Services network of community health centers in North Carolina. In Phase II, ACHIEVE will test the strategy across 20 outpatient clinics that provide prenatal and postpartum care in the Triangle region of North Carolina.
Community-based organizations in the included counties will be funded to significantly expand guidance on adapting the safety “bundle” (linked above) to various settings; they also will develop information on the signs, symptoms and treatment of hypertension in pregnancy and the postpartum period.
The leadership team for ACHIEVE includes Principal Investigator Kate Menard, MD, with UNC Obstetrics and Gynecology and the Department of Maternal-Fetal Medicine, and an interdisciplinary group of co-investigators with combined expertise in implementation science, maternal/fetal medicine, family medicine, nursing, health equity, maternal and child health, and community engagement/community-based participatory research.
Two UNC Gillings School of Global Public Health faculty are members of the group: Alexandra Lightfoot, EdD, associate professor of health behavior; and Jen Medearis Costello, MS, a leader of Equity for Moms and Babies Realized Across Chatham (EMBRACe), and an adjunct instructor for the residential Master of Public Health program.
Other collaborators include: Jennifer Leeman, DrPH, of the UNC School of Nursing; Narges Farahi, MD, from UNC Family Medicine and Piedmont Health Services; Nicole Teal, MD, of UNC’s Department of Maternal-Fetal Medicine; Kimberly Harper, MSN, RN, MHA, of the UNC Collaborative for Maternal and Infant 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,” Farahi said. “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 was 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.”
The ACHIEVE team includes a community coalition and patient action team to guide patient and community elements of the work. Kamara Barnett, a civic leader in Caswell County and patient at 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 the next phase of the 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.”
“I am delighted to be partnering with this exceptional team of researchers, health care providers and community members in their effort to improve North Carolina’s maternal health outcomes,” noted Leeman. “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; this will be followed by testing through simulation and observation in practice.
“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,” Menard said. “This is a remarkable opportunity to dig deeply into what truly works in the outpatient setting, with a laser focus on community engagement, respectful care and equity. It is not enough to know which medicines work for treatment of pregnancy-related hypertension. This study will help us to understand the best strategies for implementing sustainable lifesaving care plans. We cannot wait to get started.”
Contact the UNC Gillings School of Global Public Health communications team at firstname.lastname@example.org.