Transcript
Development of a High Risk
Obstetrics Telehealth Network
Christian A. Chisholm, M.D.
University of Virginia
School of Medicine
Background
UVA Telemedicine network
Arkansas ANGELS
UVA Telehealth Network
UVA Telehealth Network
Definition of Need
Large, widely dispersed population in a
geographically diverse state
Insufficient number of MFM specialists,
geographic concentrated in urban areas
Poor prenatal care access
Not meeting HP2010 goals (access to
prenatal care, preterm birth, perinatal
mortality)
Geographic distribution of
MFM services in Virginia
Note MFM services in Lynchburg only 2 days/month
Getting started
Established Telehealth network helps
greatly
Even with an established network, grant
support will facilitate early success
Governor’s Productivity Investment Fund
HRSA Office for Advancement of
Telehealth
Community Partners
Commitment to patients with greatest
access limitations
Health departments, community health
centers
Skill level of local providers
Communication, record-sharing, logistics
of delivery
Harrisonburg Community Health Center
Harrisonburg Community Health Center
Culpeper Health Department
Central Shenandoah Health District
Central Shenandoah Health District
Barriers to Success
Lack of support from local obstetrical
community
Misunderstanding of role; perceived
threat to local services
Miscommunication about location of
delivery
Difficult patient population
Reimbursement for uninsured patients
Early Outcome Data
Population: predominantly Hispanic,
most non-English speaking, most
uninsured
Most common problem leading to MFM
referral: diabetes. Others include
hypertension, thyroid disease, multiple
gestation, prior poor obstetrical outcome
Early Outcome Data
Cohort prior to establishment of telehealth MFM program:
Mean GA first PNV: 17.2 weeks
25% entered care after 20 weeks
10.7% rate of missed visits
After MFM telehealth program:
Mean GA first visit 14.7 weeks (deceptive)
None entered care after 20 weeks
4.4% rate of missed visits
Early Outcome Data
Other outcomes: too early / too few to
assess for differences
Preterm birth
Background rate of 10.2% reflects all women
Our subset has a higher risk for preterm birth
Diabetes control
Infant mortality
Will need more time to show a difference
Arkansas program showed 26% reduction in
infant mortality!
Early Outcome Data
Continuity – post-natal care and pediatric
care
Patient satisfaction - HIGH!
Provider satisfaction – HIGHER!
Reduced Patient Travel
HRSA sites: 20,000 miles of patient
travel saved per 6 month block
HCHC site: over 60,000 miles saved
since initiation of program
Opportunity to save substantial expense
to Medicaid in patient transportation
Other specialties available
MFM Telehealth in Virginia!
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