Impact of telemedicine in patterns of delivery of neonates.
PI/Investigator: R.Whit Hall, M.D., Core Director and Project leader; E. Garcia-Rill, Ph.D., COBRE PI.
Institution: Center for Translational Neuroscience (COBRE), Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR
Background: Although regionalization of neonatal intensive care is associated with improved outcomes, implementation has been difficult because of increased deliveries of sicker neonates in smaller nurseries. Telemedicine has been used successfully for medical care and education but it has never been utilized to modify patterns of delivery in an established state network. The Community Based Research and Education (CoBRE) Core Facility of the Center for Translational Neuroscience established a network of 15 telemedicine units with real-time teleconferencing and diagnostic quality imaging, called Telenursery, placed in Neonatal Intensive Care Units, using T1 lines to link these units with a large academic neonatal practice (UAMS and Arkansas Children’s Hospital). Weekly educational conferences were conducted to establish guidelines for neonatal and pediatric care in a program called PedsPLACE (Pediatrics Physician Learning and Collaborative Education). Patterns of delivery were assessed through a linked Medicaid database before and after the Telenursery initiative to determine if the most at risk neonates were transferred to the academic perinatal center for delivery.
Advance: Clinician satisfaction with the PedsPLACE educational conference was high as assessed through written survey instruments. Medicaid deliveries at the regional perinatal centers increased from 24% before the intervention to 33% in neonates between 500 and 999 grams (p<0.05), but they were unchanged in neonates between 2001-2500 grams. That is, the program changed the pattern of deliveries across the state such that the majority of the most premature babies were transported to UAMS, but not those with higher birth weights. Telemedicine is an effective way to translate evidence-based medicine into clinical care when combined with a general educational conference. Patterns of deliveries are changing so that those newborns at highest risk are being referred to the regional perinatal centers.
Support: Project support and Core Facilities provided by COBRE award P20 GM104325.
Public Health Impact: This study suggests that telemedicine-based education and consultation combined with guideline dissemination can be effective in enhancing access to beneficial specialty care for the management of high risk pregnancies, particularly for rural and underserved populations. In doing so, these approaches may facilitate the development of regionalized systems of perinatal care that improve access and health outcomes for low birth weight infants.
Citation and links:
Hall RW, Hall-Barrow J, Garcia-Rill E. Neonatal regionalization through telemedicine using a community-based research and education core facility. Ethn Dis 20: S1-136-140, 2010.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3323108/