Optimizing implementation strategies for guideline-concordant hypertensive disorders of pregnancy care in community clinics

The National Heart, Lung, and Blood Institute awarded the Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center $161,500 on August 20, 2026, under the Cardiovascular Diseases Research program (CFDA 93.837) to support planning activities for a future multisite cluster randomized trial on hypertensive disorders of pregnancy prevention in safety-net clinics.

The award funds a preparation phase to evaluate the feasibility and acceptability of implementation intervention components designed to improve guideline-concordant care for preventing preeclampsia. The recipient will engage 10–15 safety-net clinics across Los Angeles County to assess preeclampsia burden, current practices, and readiness for research collaboration; conduct qualitative interviews with 50 patients and clinicians to identify implementation barriers and assess current hypertensive disorder of pregnancy prevention efforts; and map candidate implementation interventions. The work addresses persistent under-prescribing of low-dose aspirin (81 mg daily) for high-risk pregnancies despite strong evidence and national guidelines, particularly in resource-constrained settings where hypertensive disorder of pregnancy risk is highest.

Performance takes place in Torrance, California. The period of performance runs through June 30, 2029. The award is classified as a Project Grant, an assistance type supporting investigator-initiated research projects.

Abstract

Background: hypertensive disorders of pregnancy (HDP), including preeclampsia, occur in 10% of pregnancies in the U.S. And contribute to maternal deaths. Preeclampsia is linked to long-term cardiovascular risk, making prevention a clinical and public health priority. Daily low-dose aspirin (LDA, 81 MG daily) in pregnancy is an effective, evidence-based prevention strategy for high-risk pregnancies. Despite strong evidence and national guidelines, LDA remains under prescribed, especially in resource-constrained settings where HDP risk is highest. Implementation interventions such as clinical decision support, universal screening, and provider education have demonstrated variable success in improving LDA prescribing and use. However, little is known about their relative and combined effectiveness in safety-net clinic environments. In our preliminary study across 11 community clinics, LDA prescribing reached only 64%, with variation by provider type, clinic setting, and risk category (high V. Moderate). We propose a future multisite cluster randomized trial using the multiphase optimization strategy (MOST) framework to evaluate the effectiveness of discrete and combined implementation interventions. This nhlbi R34 planning grant supports the preparation phase for that trial. The objective of this proposal is to evaluate the feasibility and acceptability of candidate implementation intervention components designed to improve guideline-concordant care for preventing preeclampsia in safety-net settings. Aims: we will engage 10-15 safety-net clinics across LOS angeles county to assess preeclampsia burden, current practices, and readiness for research collaboration (aim 1), conduct qualitative interviews with 50 patients and clinicians to assess current HDP prevention efforts and identify key implementation barriers (aim 2), map candidate implementation intervention components to identified barriers and define the primary optimization criteria for the trial (e.g., feasibility, reach, effectiveness) (aim 3), and evaluate the feasibility and acceptability of the proposed components among clinicians and patients (aim 4). We hypothesize that these implementation strategies will be feasible and acceptable in diverse safety-net settings. NIH and