Telemedicine collaboration improves perinatal regionalization and lowers statewide infant mortality

Abstract

OBJECTIVES We assessed a telemedicine (TM) network's effects on decreasing deliveries of very low birth-weight (VLBW, <1500 grams) neonates in hospitals without Neonatal Intensive Care Units (NICUs) and statewide infant mortality. STUDY DESIGN This prospective study used obstetrical and neonatal interventions through TM consults, education, and census rounds with 9 hospitals from July 1, 2009 – March 31, 2010. Using a generalized linear model, Medicaid data compared VLBW birth sites, mortality, and morbidity before and after TM use. Arkansas Health Department data and chi square analysis were used to compare infant mortality. RESULTS Deliveries of VLBW neonates in targeted hospitals decreased from 13.1% to 7.0% (p=0.0099); deliveries of VLBW neonates in remaining hospitals was unchanged. Mortality decreased in targeted hospitals (13.0% before TM and 6.7% after TM). Statewide infant mortality decreased from 8.5 to 7.0 per 1000 deliveries (p=0.043). CONCLUSIONS TM decreased deliveries of VLBW neonates in hospitals without NICUs and was associated with decreased statewide infant mortality..

Addressing health disparities in rural communities using telehealth

“…This resource-intensive model, relying on videoconferencing between obstetrical and neonatal teams, significantly reduced the deliveries of very-low-birth-weight infants in nine participating hospitals without NICUs from 13.1 to 7.0% (94). This finding is important because the researchers simultaneously found a concurrent and statistically significant reduction in statewide infant mortality.…”

“…In Arkansas, telemedicine-supported care in the rural setting has been shown to reduce the need for in-person visits (where the mother would have to travel to the tertiary center) by nearly 50%, while maintaining the appropriate utilization of maternal-fetal medicine subspecialty consultations (91). Studies evaluating the use of antenatal management using telemedicine have found that collaborations between a subspecialty perinatal referral hospital, and hospitals lacking neonatologists successfully reduced the number and proportion of very-low-birth-weight births at these facilities (93,94). With regard to fetal telecardiology, other researchers have demonstrated that remote diagnostic evaluations and parental counseling can be done accurately and are well accepted by providers and families (95)(96)(97).…”

Real-time video communication improves provider performance in a simulated neonatal resuscitation

“…[3][4][5][6] A few studies have demonstrated the value of telemedicine in pediatric and neonatal critical care. 7,8 One study in particular demonstrated that an infrastructure for telemedicine consultation and collaboration decreased very low birth weight deliveries at hospitals without a NICU and was associated with decreased statewide infant mortality. However, very little is known about the role of telemedicine in neonatal resuscitation.…”

Emergency Video Telemedicine Consultation for Newborn Resuscitations

“…9,10 In 2013, Kim et al 10 found that an infrastructure for perinatal telemedicine consultation and collaboration decreased very low-birth-weight deliveries at hospitals without a NICU and was associated with decreased statewide infant mortality. When general pediatric providers had real-time audiovisual communication with a neonatologist during simulated neonatal resuscitations, the time to effective ventilation (the most important intervention in newborn resuscitation) was significantly reduced.…”