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  • 1. Development of a High RiskObstetrics Telehealth Network Christian A. Chisholm, M.D. University of Virginia School of Medicine
  • 2. Background  UVA Telemedicine network  Arkansas ANGELS
  • 3. UVA Telehealth Network
  • 4. UVA Telehealth Network
  • 5. 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)
  • 6. Geographic distribution of MFM services in Virginia Note MFM services in Lynchburg only 2 days/month
  • 7. 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
  • 8. 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
  • 9. Harrisonburg Community Health Center
  • 10. Harrisonburg Community Health Center
  • 11. Culpeper Health Department
  • 12. Central Shenandoah Health District
  • 13. Central Shenandoah Health District
  • 14. 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
  • 15. 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
  • 16. 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
  • 17. 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!
  • 18. Early Outcome Data  Continuity – post-natal care and pediatric care  Patient satisfaction - HIGH!  Provider satisfaction – HIGHER!
  • 19. 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
  • 20. MFM Telehealth in Virginia!