Optimized Strategies to Support Implementation of Remote Patient Monitoring for Diabetes Management in High-Risk Pregnancy: A Feasibility Study

RESEARCH PROJECT 2: PROJECT SUMMARY/ABSTRACT Women residing in rural areas of the United States (U.S.) face higher maternal health risks, including a 9% increased likelihood of severe maternal morbidity and mortality compared to their urban and suburban counterparts. Women from rural areas experience twice the risk of severe maternal morbidity and three times the risk of pregnancy-related death. Higher rates of chronic conditions, including type 2 diabetes (T2D), and limited access to prenatal care due to obstetric workforce shortages in rural counties contribute to these adverse outcomes. Remote Patient Monitoring (RPM) presents a promising solution to improve prenatal care and manage health conditions like T2D. While there is evidence for the effectiveness of RPM among urban patients with T2D, gaps persist in its use among rural patients. The overall objective of this study is to improve health outcomes among rural pregnant patients with T2D through the implementation of RPM in a high-risk pregnancy clinic. This will be accomplished through the following specific aims: Aim 1: Assess the feasibility of RPM of glucose in high-risk pregnancy care for rural women who have T2D. We will assess reach, adoption, implementation fidelity, and maintenance/sustainment of RPM among pregnant patients with T2D in a high-risk pregnancy clinic serving rural patients. Aim 2: Explore the preliminary effectiveness of RPM of glucose in high-risk pregnancy care for rural women who have T2D. To explore the effectiveness of RPM during pregnancy, we will assess trends in maternal glycemic control and neonatal hypoglycemia. Aim 3: Engage stakeholders to assess implementation determinants of RPM of glucose in a high-risk pregnancy clinic serving rural patients and optimize implementation strategies for further testing. I will conduct qualitative interviews with rural patient participants to explore variability in RPM use. I will also conduct interviews with participating providers and clinic staff about their experience with implementation to identify barriers and assess the acceptability of implementation strategies. RPM has strong potential to address gaps in access and outcomes among rural women, but several systematic reviews have demonstrated lack of participation in digital health innovation among rural communities. This study will be used to create an optimized package of implementation strategies that can be tested in a fully powered R01 Hybrid Type 1 effectiveness-implementation trial (PAR-22-105).