Development of a High Risk
Obstetrics Telehealth Network
   Christian A. Chisholm, M.D.
   University of Virginia
   Schoo...
Background

  UVA Telemedicine network
  Arkansas ANGELS
UVA Telehealth Network
Definition of Need

  Dispersed population
  Insufficient number of MFM’s,
   geographic concentration
  Poor prenatal ...
Geographic distribution of
 MFM services in Virginia




        Note MFM services in Lynchburg only 1 day/week
Getting started

  Established Telehealth network helps
   greatly
  Even with an established network, grant
   support ...
Community Partners

  Commitment to patients with greatest
   access limitations
  Health departments, community health
...
Harrisonburg Community Health Center
Harrisonburg Community Health Center
Barriers to Success

  Lack of support from local obstetrical
   community
  Miscommunication about location of
   deliv...
Early Outcome Data

  Population: predominantly Hispanic,
   most non-English speaking, most
   uninsured
  Most common ...
Early Outcome Data

    Cohort prior to establishment of
     telehealth MFM program:
      Mean GA first PNV: 17 weeks
...
Early Outcome Data

    Other outcomes: too early /too few to
     assess for differences
      Preterm birth
      Dia...
MFM Telehealth in Virginia!
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Chisholm

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Chisholm

  1. 1. Development of a High Risk Obstetrics Telehealth Network Christian A. Chisholm, M.D. University of Virginia School of Medicine
  2. 2. Background  UVA Telemedicine network  Arkansas ANGELS
  3. 3. UVA Telehealth Network
  4. 4. Definition of Need  Dispersed population  Insufficient number of MFM’s, geographic concentration  Poor prenatal care access  Not meeting HP2010 goals (preterm birth, perinatal mortality)
  5. 5. Geographic distribution of MFM services in Virginia Note MFM services in Lynchburg only 1 day/week
  6. 6. 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
  7. 7. 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
  8. 8. Harrisonburg Community Health Center
  9. 9. Harrisonburg Community Health Center
  10. 10. Barriers to Success  Lack of support from local obstetrical community  Miscommunication about location of delivery  Difficult patient population  Insurance reimbursement for telehealth
  11. 11. 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
  12. 12. Early Outcome Data  Cohort prior to establishment of telehealth MFM program:  Mean GA first PNV: 17 weeks  25% entered care after 20 weeks  Frequent missed visits  First year of MFM telehealth program:  Mean GA first visit 13 weeks  None entered care after 20 weeks  Only 3 missed visits among entire cohort
  13. 13. Early Outcome Data  Other outcomes: too early /too few to assess for differences  Preterm birth  Diabetes control  Continuity – post-natal care and pediatric care  Patient satisfaction - HIGH!
  14. 14. MFM Telehealth in Virginia!

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