Implementing Equitable Hypertension Care Using a Remote Patient Monitoring Program: A Mixed Methods Study

Systems-level approaches can promote equitable hypertension outcomes. Remote patient monitoring (RPM) is a patient-centered hypertension solution, but successful implementation strategies require further exploration.

This study was designed to determine social and institutional factors of RPM utilization at an academic medical center.

We used a mixed methods study design. Using logistic regression, we retrospectively assessed the relation of sociodemographic variables with RPM engagement, achievement of normotension, and maintenance of normotension at 180 days post-RPM. We completed Cox regression and Kaplan-Meier analyses to investigate the association of level of engagement and achieving normotension outcome. To augment the quantitative analysis, we concurrently interviewed RPM staff members to assess systems-level themes of RPM program implementation. The interviews were recorded, transcribed, and inductively coded using a validated implementation framework.

We analyzed 1744 RPM program participants (mean age 63.1 years, 64.7% female, 82.6% Black) between May 2022 and August 2024. Patients with higher RPM engagement were older than those with lower engagement (65.6 years vs 62.3 years). The high engagement group differed by race, with more Black individuals in the high engagement group. High engagement (OR: 2.06; 95% CI: 1.51-2.84; P < 0.001) was associated with likelihood of normotension and had a shorter time to normotension (HR: 2.52; 95% CI: 2.14-2.98; P < 0.001). Ten key staff provided important insights of barriers and facilitators of RPM implementation that converged with statistical analyses.

An RPM program successfully improved blood pressure care, especially among patients with higher program engagement. These findings reveal opportunities for achieving equitable hypertension outcomes.