Take home point
In a recent article in the Journal of Perinatology, researchers reported that telemedicine intervention contributed to lowering the number of very low birth weight neonates delivered in hospitals without neonatal intensive care units (NICUs) in Arkansas.
The article also pointed out that there was an associated decrease in the statewide infant mortality rate in Arkansas.
Very low birth weight neonates have higher rates of morbidity and mortality. These neonates should receive care in Level III perinatal centers. However, these centers do not exist in many regions of the country, particularly rural areas. This lack of regional centers to provide subspecialty care for these children or “regionalization” is a problem that the researchers sought to address with the intervention of telemedicine. Their question was whether telemedicine could lower very low birth weight deliveries in hospitals that lacked NICUs. They also asked whether this intervention could affect morbidity and mortality among these children and whether statewide infant mortality would decrease as a result of a telemedicine intervention.
Approach to Address Problem
The researchers conducted a prospective study which included a multi-prong, intensive obstetric and neonatal intervention including telemedicine consultations, education, and census rounds with nine hospitals from July 1, 2009 to March 31, 2010. The intervention was called the TM Outreach Utilizing Collaborative Health-care Program or TOUCH Program. The nine hospitals selected were chosen for their high volume of births. The University of Arkansas for Medical Sciences coordinated the TOUCH Program. They also used an existing statewide system for high risk obstetrics and neonatology called Antenatal and Neonatal Guidelines, Education and Learning System (ANGELS) as infrastructure for the telemedicine intervention.
The intervention was comprised of numerous educational and consultation activities to improve the quality of care at the nine hospitals including 24/7 obstetrics consultation through the ANGELS Call Center and also 24/7 neonataology consultations. In essence, the TOUCH program became the Level III perinatal center that these hospitals lacked. UAMS was made aware of potential high risk patients that might need transport to UAMS through regular census rounds with the hospitals.
The results of this well tailored intervention are clear. Deliveries of very low birth weight neonates declined in the targeted hospitals from 13.1 to 7.0% (P value = .0099). However, deliveries of very low birth weight neonates in other hospitals remained unchanged. Mortality also decreased in the targeted hospitals from 13.0% to 6.7%. Finally, there was a drop in infant mortality for the state of Arkansas from 8.5 to 7.0 per 1000 deliveries ( p = .043).
Implications for clinicians/health care system
The findings of this intervention demonstrate that clinicians can work together through a telemedicine system to improve the quality of care they are providing to patients. With ongoing coordination and collaboration, they can prevent morbidity and mortality that arise from very low birth weight infants. Telemedicine provides a useful tool for parts of the country where the best medical care is localized to a certain area in the state.
Implications for public health
The public health implications of this research are tremendous. Morbidity and mortality associated with very low birth weight infants is a problem which vexes many departments of health throughout the country. This research illustrates that increasing quality of care–an achievable goal for most states–can actually address this problem. Although other social determinants of health must be addressed to completely solve the problem of very low birth weight infants, this research suggests that there are risk factors which public health officials and health professionals can address that can improve health outcomes for America’s newborns.
Future research concerns/challenges
Future concerns for this research include replication in other states and ongoing documentation of what led to the success Arkansas had with the TOUCH Program. Perhaps one challenge for the researchers will be helping other centers replicate the extensive nature of their intervention, which may be too difficult for some health systems to achieve because of the additional work that may be involved.
Other challenges might include reimbursement for the work being done by practitioners in Arkansas. The TOUCH Program involved coordination with the Centers for Medicaid and Medicare Services. Similar programs in other states are likely to need federal support of these type of programs, which as the researchers demonstrate can lead to benefits for state and federal governments.