By Shayna Mace | Photo courtesy Dr. Kara Hoppe
Dr. Kara Hoppe, fetal medicine doctor and associate professor at the University of Wisconsin School of Medicine and Public Health, has the best of both worlds: She meets with patients as well as spearheads important research concerning hypertension in birthing people during and post-pregnancy.
“I feel like research is the way to make changes that inform care and to … improve care for people. I wanted to make sure research was a part of my career. So much so that I started a master’s degree in clinical investigation at the university here when I joined the faculty,” explains Dr. Hoppe.
Cardiovascular disease and hypertension have always interested Dr. Hoppe, particularly how they influence poor outcomes in pregnancy.
“[These are] high drivers of maternal morbidity and mortality. We were seeing all of these people be readmitted after birth [for high blood pressure]. Our rate was 3 to 5% when I got here. In some places across the country, it’s as high as 10%.”
She explains the standard of care for most postpartum patients is to come to the clinic seven to 10 days after birth and have their blood pressure checked. However, she noticed many patients would come to the ER prior to this with elevated blood pressure readings, often leading to hospital readmissions. Dr. Hoppe wondered why this was the case. She knew that (non-pregnant) patients with heart failure went home with a heart monitor that was monitored remotely had improved outcomes. Why couldn’t they give postpartum patients a blood pressure device to use remotely at home?
“I started really small in 2017 with some pilot seed funding from the Meriter Foundation. They gave me 30 devices to send people home with. Within a month, my devices were all gone, and the program was highly desired!”
Dr. Hoppe’s study revealed that if patients used the blood pressure device postpartum compared to the standard of care (no blood pressure monitor), she and her staff could easily call in blood pressure medications for those with elevated readings so their blood pressure was controlled at home. When the trial ended in 2019, Dr. Hoppe says the hospital readmission rate was significantly reduced. Those with the devices had a 0.5% readmission rate compared to a 3.7% readmission for those without the devices.
When creating a new care model, she notes that closing the gap on disparities and reaching all populations equitably should be built in. After she and her staff broke down the numbers from their pilot study, they came across an interesting finding.
“We specifically saw our Black participants had lower submissions of blood pressure [readings]. We thought if we could combine community and the health care team together, maybe we could get better engagement and support,” she says.
Dr. Hoppe and her staff held focus groups to inquire about barriers for Black birthing people and the idea of collaborating with community doulas was implemented. Her program has partnered with both Harambee Doula Care and Holistic Services and The Foundation for Black Women’s Wellness, among other statewide health care organizations.
Today, Dr. Hoppe’s brainchild, Staying Healthy After Childbirth (STAC), is a success story. It’s a fully funded program that’s monitored thousands of patients annually.
“It’s the largest [postpartum blood pressure monitoring] program across Wisconsin and one of the biggest in the country too,” says Dr. Hoppe. “And it was all because I felt [there] was a problem with the way we were caring for people and there was a solvable answer. I think it’s the wave of the future.”
