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
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