That gap between evidence-based recommendations and their implementation in routine care is the focus of a new three-year R34 award from the National Heart, Lung, and Blood Institute (NHLBI), led by Bridgette Blebu, PhD, MPH, an investigator in the Translational Science and Population Health Innovation Hub at The Lundquist Institute.
The project builds on findings that, despite established evidence supporting interventions such as daily low-dose aspirin to reduce the risk of preeclampsia—a serious pregnancy complication characterized by high blood pressure and affecting about 1 in 10 pregnancies in the United States—these preventive approaches remain underutilized.
These findings raised a broader set of questions about the structural, clinical, and patient factors that shape how clinicians identify risk, how recommendations are incorporated into routine workflows, and what support patients may need after a prescription is made.
R34 grants support early-stage work needed to prepare for a future clinical trial or larger research study. This can include refining the study design, developing recruitment and data collection procedures, assessing feasibility, and establishing the partnerships and infrastructure needed for a subsequent trial.
“I’m grateful that the R34 grant exists. The value of the planning phase is that it gives us an opportunity to understand the clinical context before deciding exactly what should be tested,” Blebu said. “Rather than assuming that the same approach will work in every setting, we can learn from patients, clinicians, and health system partners about where the barriers are and what may be realistic within different care environments.”
As an initial step, she plans to build research partnerships with community clinics across Los Angeles County, interview patients and clinicians to better understand barriers and facilitators, and identify strategies that may be appropriate for testing at scale.
Dr. Blebu’s focus on safety-net and community health settings is intentional. Community clinics are not just settings that serve patients with complex medical and social factors; they also bring deep community knowledge, trusted relationships, and practical expertise in delivering care under real-world conditions that are not always represented in trials.
Her interest also reflects an earlier line of research examining maternal and birth outcomes among Black immigrant populations in California, a population that was relatively understudied compared with Black immigrant populations in more established destination settings. That work reinforced the importance of asking how health patterns may differ in populations and settings that are less represented in the existing evidence base—a lens she continues to bring to her translational research today.
Her long-term vision extends beyond this grant: equipping health systems with better tools to understand the full context of a patient’s health, including both risk and protective factors, early enough to support care planning with patients. The R34 provides a foundation for that longer-term work.
Findings from the planning phase will inform the design of a future multisite clinical trial evaluating which strategies, or combinations of strategies, may be most useful for improving the delivery of evidence-based preeclampsia prevention in ways that are responsive to both patients and clinicians.