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Hypertension in PregnancyRI-SPHERESNCT06842875

Rhode Island - Statewide Postpartum Hypertension Remote Surveillance

A study testing RI-SPHERES and Standard self-measured blood pressure program in people with Hypertension in Pregnancy and Postpartum Preeclampsia, run by Women and Infants Hospital of Rhode Island at 5 sites in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

This is a hybrid type 1 non-inferiority implementation effectiveness trial among postpartum patients with hypertension (N=1536) that will test the hypothesis that RI-SPHERES (a technologically enabled collaborative care model) is non-inferior to a standard self-measured blood pressure program in terms of persistent… Read more about this study

Who is it for?
Ages 18 to 60 years, women only
What is being tested?
RI-SPHERES and Standard self-measured blood pressure program
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,536 participants
Where
5 sitesUnited States
Study dates
15 Apr 2025to 1 Mar 2029
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 60 years
  • Women only
  • No healthy volunteers
  • Adult

Who may be able to join

  • Postpartum patient aged 18 years or more at any birthing hospital in Rhode Island
  • Diagnosed during pregnancy or after delivery with hypertensive disorder of pregnant
  • English-, Spanish-, Portuguese-, or Haitian-Creole-speaking
  • Smartphone ownership

Who cannot join

  • Prior enrollment in this trial
  • Prisoners or incarcerated people
  • Inability or unwillingness to provide informed consent
  • Inability to communicate with study team, despite an interpreter

Trial locations and contacts

5 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Stephanie Nunez, Research Coordinator contact

401-274-1122

snunez@wihri.org

5 sites in 1 country

United States5 sites, 5 recruiting
  • Newport Hospital

    Newport, Rhode Island, 02840

    Emily Blosser, MD, PhD, 401-846-6400, eblosser@lifespan.org

    Not yet recruiting
  • Women & Infants Hospital of Rhode Island

    Providence, Rhode Island, 02903

    Stephanie Nunez, BS, 401-274-1122, snunez@wihri.org

    Adam Lewkowitz, MD, MPHS

    Recruiting
  • South County Hospital

    Wakefield, Rhode Island, 02879

    Megin Dalton, MD, 401-782-8000, mdalton@southcountyhealth.org

    Not yet recruiting
  • Kent Hospital

    Warwick, Rhode Island, 02886

    Jen Buckley, MD, 401-227-3669, JBuckley@carene.org

    Caroline Richardson, MD

    Recruiting
  • Landmark Hospital

    Woonsocket, Rhode Island, 02895

    Sue Magee, MD, 401-769-4100, susannamagee@gmail.com

    Recruiting

Other trials in United States

About this study

Official title: Effect of a Technology-based Collaborative Model on Persistent Hypertension and Preventive Care Attendance Among Postpartum People With Hypertensive Disorders of Pregnancy

This is a hybrid type 1 non-inferiority implementation effectiveness trial among postpartum patients with hypertension (N=1536) that will test the hypothesis that RI-SPHERES (a technologically enabled collaborative care model) is non-inferior to a standard self-measured blood pressure program in terms of persistent hypertension at six weeks postpartum and preventive care receipt within one year of delivery.

Read the detailed description

Uncontrolled hypertensive disorders of pregnancy (HDP) are a major source of maternal mortality. National guidelines recommend blood pressure (BP) measurement 3-10 days after discharge and ≥1 preventive care visit within one year of delivery. Yet, barriers such as childcare or transportation issues reduce adherence to in-person BP checks, particularly among racial or ethnic minority patients. Programs in which patients self-measure BP (SMBP) at home show promising results regardless of patient race. However, a recent meta-analysis concluded current SMBP programs do not reduce maternal mortality or racial disparities in clinical outcomes, potentially due to their specific limitations: they end within six weeks of birth (though HDP can persist for months) and have decreased engagement with non-White people or those living in disadvantaged areas, though these populations are at the highest risk of persistent HTN and its adverse long-term effects. Thus, there is an urgent need to optimize SMBP programs to target short- and long-term HDP-related morbidity and to broadly implement these programs to eliminate disparities in HDP-related outcomes. One such program is Rhode Island (RI)-Statewide Postpartum HypErtension REmote Surveillance (RI-SPHERES), a technology-based SMBP program that aims to reduce short- and long-term HDP-associated morbidity in RI using the collaborative care model, a health services intervention that improves health outcomes and reduces racial disparities on a population level for people with chronic conditions. The proposed research aims to determine the effectiveness of RI-SPHERES in reducing short- and long-term morbidity associated with HDP throughout RI. This builds upon our pilot RCT (NCT05595629), in which a standard SMBP program was compared to a SMBP program that used a Bluetooth-enabled BP cuff that syncs to a smartphone application (app) to send automated reminders and provide adaptive messaging tailored to distinct BP values and symptoms. RI-SPHERES will expand this SMBP program to provide app-based patient-informed educational content on HDP-specific preventive care and bidirectional communication with RI-SPHERES staff for one year postpartum. Incorporating adaptive and automatic messaging increases RI-SPHERES' scalability by reducing clinical staff burden. However, formal analysis of factors that may hinder widespread implementation of RI-SPHERES is needed. Thus, we will conduct a Hybrid Type I Non-Inferiority Implementation-Effectiveness Trial among 1536 patients with HDP that compares a standard SMBP program to RI-SPHERES in terms of persistent HTN at six weeks postpartum and receipt of preventive care within one year of delivery (Specific Aim 1). We will examine the effect of both programs on increasing equity in terms of race, ethnicity, language, and geography for postpartum patients with HDP in Rhode Island (Specific Aim 2). We will also develop an implementation toolkit to facilitate the dissemination of RI-SPHERES (Specific Aim 3). The proposed project is expected to deliver a mechanism that will fill multiple research gaps for HDP identified by the US Preventive Services Task Force: 1) addressing health inequities through multilevel interventions, 2) evaluating SMBP programs; and 3) mitigating HDP's short- and long-term health consequences of HDP.

Being tested
RI-SPHERES, Standard self-measured blood pressure program
Keywords
postpartum hypertensive disorders of pregnancy, postpartum preeclampsia, digital health, collaborative care model, population health, self-measured blood pressure
Medical subject headings
Hypertension, Pregnancy-Induced

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • RI-SPHERESBehavioural

    Participants assigned to the RI-SPHERES group will be introduced virtually or in-person to the care manager (CM), who demonstrate how to communicate directly with patients through the app for medical or non-medical needs. Each participant will learn how to obtain SMBP, sync the LTE-enabled BP cuff to the RI-SPHERES app, and respond to adaptive messaging pertaining to BP measurements, which include the ability to receive on-demand education on postpartum topics (e.g., HDP, breastfeeding, mood disorders) per participant preference. During the study period, the CM will respond to needs elicited from the SDoH screening by facilitating referrals to community resources. After six weeks, the focus of RI-SPHERES will transition to preventive care in addition to SMBP. The CM will engage monthly with each study participant to ensure they have a primary care provider and to facilitate preventive care visits or specialist appointments, if needed.

  • Standard self-measured blood pressure programBehavioural

    Participants assigned to the routine care group meet virtually or in-person with a member of WIH's existing SMBP program and enroll in WIH's EPIC MyChart Portal to allow the SMBP program to receive patient-entered BP measurements and respond to messages. Participants will be provided with BP cuffs and taught how to obtain SMBP and report their BP through MyChart. At six weeks postpartum, WIH SMBP staff send a MyChart message to recommend BP ascertainment once per month and to describe the importance of attending a clinical visit with a primary care provider within a year of birth.

Study groups in NCT06842875
Study groupRoleWhat they receive
RI-SPHERESExperimentalA technology enabled collaborative care model. Participants will receive a LTE-enabled blood pressure (BP) cuff that syncs to a smartphone application (app) to send automated reminders and provide adaptive messaging tailored to distinct BP values and symptoms. The first six weeks of the program will focus on BP control, and the remaining time will help transition people to receive recommended preventive care. As part of the collaborative care model, the nurse practitioner will lead weekly meetings with a multidisciplinary clinical team about all enrolled people.
Receives: Behavioral: RI-SPHERES
Standard self-measured blood pressure programActive comparatorOur hospital has a remote hypertension monitoring program that recommends daily blood pressure ascertainment for 6 weeks, at which time they are discharged and provided printed resources to encourage preventive care in the next few months. In this program, patients manually enter their self-measured BPs into the electronic medical record for the clinical team to manually review and respond.
Receives: Behavioral: Standard self-measured blood pressure program

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Persistent hypertension

    Persistent stage II hypertension will be defined as systolic blood pressure of 140 mmHg or higher and/or diastolic blood pressure of 90 mmHg or higher

    Measured: Six weeks postpartum

Secondary outcomes (14)
  1. Attendance of preventive care visit

    Participant attends a non-urgent appointment during which an internal medicine physician, family medicine physician, or primary care advanced practice provider (APP, including nurse practitioners or physician assistants) ascertains BP and provides patient counseling pertaining to HTN. While obstetrician-gynecologists (OBGYNs) or certified nurse midwives (CNMs) can provide preventive care, for this aim, visits provided by an OBGYN or CNM will only qualify if the visit occurs ≥6 weeks postpartum and the medical record states that HTN was discussed in the visit.

    Measured: From six weeks postpartum until one year postpartum

  2. Blood pressure ascertainment

    Participant measured any BP (either in-person or via self-measured blood pressure)

    Measured: 1-10 days after hospital discharge

  3. Total number of self-measured blood pressure assessments provided to program in immediate postpartum period

    Number of blood pressures sent in to the participant's self-measured blood pressure program (RI-SPHERES or standard program)

    Measured: Hospital discharge to six weeks postpartum

  4. Total number of self-measured blood pressure assessments provided to program after six weeks postpartum

    Number of blood pressures sent in to the participant's self-measured blood pressure program (RI-SPHERES or standard program)

    Measured: Six weeks postpartum until one year postpartum

  5. Severe maternal morbidity after hospital discharge

    Severe maternal morbidity, as defined by the Centers for Disease Control's composite.

    Measured: Hospital discharge until 6 weeks postpartum

  6. Persistent stage I hypertension

    Systolic blood pressure between 130-139 mmHg and/or diastolic blood pressure between 80-89 mmHg

    Measured: Six weeks, six months, and 12 months postpartum

  7. Persistent stage II hypertension

    Systolic blood pressure at or above 140 mmHg and/or diastolic blood pressure at or above 90 mmHg

    Measured: Six and 12 months postpartum

  8. Severe hypertension after hospital discharge

    Systolic blood pressure at or above 160 mmHg or diastolic blood pressure at or above 110 mmHg on two or more occasions

    Measured: Hospital discharge to 6 weeks postpartum

  9. Emergency room visit for hypertension-related etiology

    Presentation to emergency room for hypertension-related chief complaint

    Measured: Hospital discharge to 6 weeks postpartum

  10. Readmission to inpatient hospital for hypertension-related etiology

    Readmission to inpatient hospital for hypertension-related chief complaint

    Measured: Hospital discharge until 6 weeks postpartum

  11. Initiation or titration of antihypertension medication

    Initiation or increase in dose titration of antihypertensive medication(s)

    Measured: Hospital discharge to 6 weeks postpartum

  12. Postpartum visit attendance

    Attendance to the recommended in-person postpartum visit

    Measured: Four to six weeks postpartum

  13. System usability scale

    A 10-question survey designed to provide a global view of subjective assessments of usability for a technology-based program or intervention

    Measured: Six weeks, six months, and 12 months postpartum

  14. Client satisfaction questionnaire

    A survey designed to provide an overview of individual satisfaction with a program or intervention

    Measured: Six weeks, six months, and 12 months postpartum

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Feb 2025
  2. Study start15 Apr 2025
  3. Primary completion1 Mar 2029 (estimated)
  4. Study completion1 Mar 2029 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Health services research
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Care provider, Investigator, Outcomes assessor
Enrolment
1,536 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06842875
Sponsor's protocol ID
2184383
Acronym
RI-SPHERES
Status last verified
Feb 2025
First submitted
18 Feb 2025
Last updated
17 Jun 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Data will be collected from human subjects and will be shared according to NIH guidelines. The investigators are committed to the sharing of final data, being mindful that the rights and privacy of people who participate in research must be protected at all times. The investigators will make a complete study dataset available for sharing. The investigators will have a description of study dataset, including code books, meta-data related to the dataset, and documented programming code used for creating the final study population, for creating variables, and for conducting all outcomes analyses. The investigators will remain HIPAA compliant, and therefore any datasets resulting from participants will be free of any identifiers that would permit linkages to individual research participants and variables that could lead to deductive disclosure of individual subjects.

Publications

  • Nunez SD, Spratt LM, Ware CF, Machado S, Rousseau J, Jackson TL, Buckley J, Magee S, Wohler D, Blosser E, Sales S, Simmons D, Ramos VN, Castillo MM, Murray C, Bailey K, Gutman R, Richardson CR, Grobman WA, Hauspurg A, Miller ES, Tuuli MG, Lewkowitz AK. Protocol for a type 1 hybrid effectiveness implementation trial to evaluate whether a technology-based collaborative care model is non-inferior to remote blood pressure monitoring on persistent hypertension and preventive care attendance among postpartum people with hypertension. Contemp Clin Trials. 2025 Dec;159:108114. doi: 10.1016/j.cct.2025.108114. Epub 2025 Oct 23.

    PubMed 41139061

Questions about this trial

What is this clinical trial studying?

A study testing RI-SPHERES and Standard self-measured blood pressure program in people with Hypertension in Pregnancy and Postpartum Preeclampsia, run by Women and Infants Hospital of Rhode Island at 5 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 17 Jun 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 5 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Stephanie Nunez, Research Coordinator (401-274-1122, snunez@wihri.org), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Persistent hypertension (time frame: Six weeks postpartum). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06842875, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 17 Jun 2025.

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