Development of a High Risk

Obstetrics Telehealth Network

Christian A. Chisholm, M.D.

University of Virginia

School of Medicine

Background

UVA Telemedicine network

Arkansas ANGELS

UVA Telehealth Network

UVA Telehealth Network

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

Harrisonburg Community Health Center

Harrisonburg Community Health Center

Culpeper Health Department

Central Shenandoah Health District

Central Shenandoah Health District

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

MFM Telehealth in Virginia!