Designing a usable clinician report for home blood pressure monitoring in pregnancy: a mixed methods study

Hypertensive disorders of pregnancy (HDPs) are leading causes of maternal and fetal morbidity; yet uptake of home blood pressure monitoring (HBPM) for perinatal detection and management of hypertension remains limited by workflow and integration barriers. We designed and evaluated a clinician-facing HBPM report that integrates blood pressure trends, medication adherence, and pregnancy symptoms to support clinical adoption.

Between March 2023 and October 2024, we designed and refined HBPM report prototypes through a mixed-method study that included interviews with 16 obstetric providers, using iterative input from a multidisciplinary Clinician Advisory Group. Data on preferences for report features, usability, and workflow integration drawn from provider interviews were compiled and synthesized via convergent quantitative and qualitative methods.

Sixteen providers (37.5% nurses, 25% residents, 25% attendings, 12.5% APPs) were interviewed. Providers identified the blood pressure graph, abnormal-value highlights, medication adherence tracker, and symptom log as the most useful features (n = 15-16, ≥90%), while the prenatal vitamin tracker was least useful (n = 9, 56%). Most providers preferred to review the report themselves (n = 11, 73%) and to receive it at a frequency based on clinical need (n = 12, 80%). While most clinicians were willing to integrate the report into their practice, they raised concerns about workflow burden, triage of abnormal readings, and EMR integration as barriers to successful integration.

Providers found most elements of the HBPM tool useful for HDP management, but identified workflow and implementation challenges as key barriers, highlighting the need for strategies to support clinical integration.