UseofTelemedicineinPerinatalCare

Dr.SanjayMitraCathyRichards,RN,EMT-P,MCCN

ChristyDixon,RRT,RN

Dr.SanjayMitraFinancial—Norelevantfinancialrelationshipexists.Nonfinancial—CentralAdvisorCouncilMemberforWVPerinatalPartnership:Receivesnocompensationasmemberofthiscouncil.

CathyRichards,RN,EMT-P,MCCN

Financial—Norelevantfinancialrelationshipexists

Nonfinancial—Norelevantnonfinancialrelationshipexists.ChristyDixon,RRT,RN

Financial—NorelevantfinancialrelationshipexistsNonfinancial—Norelevantnonfinancialrelationshipexists.

DisclosureStatement

*  HealthCaredisparityinPerinatalCare*  PerinatalCareStatus&OutcomeinthestateofWestVirginia*  ReviewoftheGoldenHour*  Technologyintransporttoovercomesomeofthebarriers

Objectives

*  Almost21,000babiesareborninthestateofWestVirginiaeveryyear.*  40%oflivebirthsoccurinthreestatewidelevelIII/IVcareperinatalcenter.*  73%ofthebirthingcentersinthestatehavelessthan750deliveries/year.*  Almost8to10%ofnewborninfantsinthestateareadmittedtolevelIII/IVcareNICU.

WVStatistics

Definition

*  Healthdisparitiesarepreventabledifferencesintheburdenofdisease,injury,violence,oropportunitiestoachieveoptimalhealththatareexperiencedbysociallydisadvantagedpopulations.*  Populationscanbedefinedbyfactorssuchasraceorethnicity,gender,educationorincome,disability,geographiclocation(e.g.,ruralorurban),orsexualorientation.

FactorscausingHealthdisparity

*  Poverty*  Environmentalthreats*  Inadequateaccesstohealthcare*  Individualandbehavioralfactors*  Educationalinequalities

2013WVBirthsbyHospitalHospital #Births Hospital #Births

AppalachianRegional 57 PrincetonCommunityHospital

697

BerkeleyMedicalCenter 1,101 RaleighGeneralHospital 1,275

BluefieldRegional 622 ReynoldsMemorialHospital 96

CabellHuntington 2,733 RubyMemorialHospital 1,571

CamdenClark 1,707 St.Mary’sHospital 398

CAMC 2,669 St.Joe’s(Buckhannon)Hospital

295

DavisMemorial 331 StonewallJacksonHospital 314

FairmontGeneral 419 SummersvilleRegionalMed.Ctr

316

GarrettCountyMemorial 280 ThomasMemorialHospital 1,085

GrantMemorial 263 UnitedHospitalCenter 986

GreenbrierValleyMedicalCtr 571 WeirtonMedicalCenter 571

JeffersonMemorial 257 WelchEmergencyHospital 70

LoganRegional 332 WheelingHospital 1,275

MonongaliaGeneral 1,088 WilliamsonMemorialHospital

100

OhioValleyMedicalCenter 303 WomanCare 7

PleasantValley 146

MaternalHealthProviderShortageAreas

Locations of Open and Closed Birth Facilities

Locations of Level III Perinatal Referral CentersLocations of Level I and II obstetric services

Birth Facilities That Have Closed Since 19761. Morgan City War Memorial2. Hampshire Memorial3. Potomac Valley Hospital4. Tucker County Hospital5. Broaddus Hospital6. Grafton City Hospital7. Sistersville General Hospital8. Memorial General Hospital, Elkins9. Webster County Hospital?10. Richwood Community Hospital?11. Pocahontas Memorial Hospital12. New River Birth Center13. Appalachian Regional Hospital 14. Calhoun General Hospital15. Putnam General Hospital16. WVSOM Birth Center17. Rainelle Medical Center Birth Center18. Dr. Vincent’s Birth Center19. Jackson General Hospital (2004)20. Women’s Health Center Birth Center21. Boone Memorial Hospital22. Hinton Hospital23. Summers County Hospital24. Stevens Clinic25. Doctors’ Memorial26. Wyoming General Hospital27. Montgomery General28. Oak Hill Hospital29. Guthrie Hospital30. Lincoln County Clinic31. Holden Hospital32. Man Appalachian Regional33. Wetzel County Hospital (closed 2006)34. Roane General Hospital (closed 2009)35. Preston Memorial Hospital (Closed 2011)36. St. Josephs, Hospital Wood County merged

with Camden Clark Memorial Hospital37. Reynolds Memorial Hospital (2012)

1

23

45

6

7

8

9

11

1213

14

15

16 17

18

19

1020

21

22 23

2425

302728

29

3132

26

33

34

3536

PrenatalCareShortageAreasdeliveringatStonewallJackson

LevelI

Braxton Gilmore

PrenatalCareShortageAreasdeliveringatGrantMemorial

LevelI

Hardy Pendleton

PrenatalCareShortageAreasdeliveringatCamdenClark

LevelI

Richie Wirt

PrenatalCareShortageAreasdeliveringatCamdenClark

LevelI

Calhoun Pleasants

PrenatalCareShortageAreasdeliveringatUHC

LevelI

Taylor

StatusonPrenatalCareandOutcomes

The State of Perinatal Health

in West Virginia 2006-2013

Low Birth Weight (<2,500 GMS) Among WV Residents * 2006 9.8% * 2011 9.6% * 2012 9.2% * 2013 (preliminary) 9.4%

DataSource:WVHealthStatisticsCenter,VitalStatisticsSystem

Very Low and Low Birth Weight By Age of Mother, WV Residents

Age Of Mother

2006 % Very Low and Low BW

2012 % Very Low and Low BW

2013* % Very Low and Low BW

10-14 18.2% 12.5% 9.5%15-17 12.5% 12.0% 10.1%18-19 11.3% 10.5% 11.3%20-24 10.7% 9.0% 9.1%25-29 8.9% 8.2% 8.9%30-34 9.1% 9.0% 9.0%35+ 8.6% 11.2% 11.0%

*Preliminary Data

DataSource:WVHealthStatisticsCenter,VitalStatisticsSystem

PercentageofVeryLowBirthWeightInfants(450-1499gm)byPlaceofBirth,2000-2009

80.7

19.3

0102030405060708090

TertiaryHospitals Non-TertiaryHospitals

DataSource:WVHealthStatisticsCenter,VitalStatisticsSystem

WV Birth Outcome Rankings, 2013

Data Source: National Center for Health Statistics

BirthOutcome

WV U.S. WVRank

CesareanDelivery

35.9% 32.8% 6th

PretermBirths

12.4% 11.5% 13th

LowBirthWeight

9.2% 8.0% 7th

VeryLowBirthWeight

1.5% 1.4% 18th

TeenBirthRate

44.1per1,000 29.4per1,000

6th

InfantMortalityRates

MortalityRatesbyCause,*2008-2010

12%15%

13% 13% 15%26%

14% 15%

18% 15%17%

18% 19%

19%

18% 20%

8%11%

13%13% 12%

17%

13% 13%

48%

44%47% 42% 40%

26%

42%

36%

0.0

100.0

200.0

300.0

400.0

500.0

600.0

700.0

800.0

900.0

1000.0

DC DE MD PA VA WV RegionIIITotal

U.S.Total

InfantDeathsp

er100,000

Preterm-related

OtherPerinatalCondiIons

CongenitalAnomalies

SUID

InfecIon

Injury

AllotherCauses

St. Joseph's Hospital, Buckhannon Stonewall Jackson Memorial Hospital, Weston

Davis Memorial Hospital , Elkins

WVU Children’s Hospital

Summersville Regional Medical Center, Summersville

CAMC Women’s and Children’s Hospital

Greenbrier Valley Medical Center, Ronceverte

Cabell Huntington Hospital

Williamson Memorial Hospital

WV Tertiary Perinatal Referral Centers

Telemedicine sites

WV Obstetric Hospitals Telemedicine sites

Prenatal Clinics Telemedicine sites

Connect To Care West Virginia Perinatal Telehealth Project

Valley Health Systems, Mill Creek

Primary Care Systems, Clay

Community Health Foundation Of Man, Inc

Valley Health Care, Wayne

Valley Health Care, Fort incoln PGriamyary Care Center, Inc

FamilyCare, Madison

Grant Memorial Hospital, Petersburg

Roane County Family Health Care

Prepared by Ann Dacey (All locations are approximate)

Thestandardized,evidence-basedprocessofcarefortheVLBWinfantinthefirsthouroflifetopreventcomplicationsthatmayhavelifelong

effectsontheinfant.Immediate

* Hypothermia* IntraventricularHemorrhage

Sequelae

*  ChronicLungDisease*  RetinopathyofPrematurity*  Death*  NeurodevelopmentalImpairment

TheGoldenHour

*  CriticallysickneonateneedsimmediateICUcareforbetteroutcomes.*  Birthingcenters(LevelI/II)needsimmediateassistanceandtransfer*  LevelIII/IVperinatalcarecenterssendteamtoassistandtransfertothecenterequippedwithdesiredlevelofcare*  Delaycanoccurduetopoorweatherconditionsandtraveltime.

CareDuringGoldenHour

WVPediatricTelemedicineServices

*  WVUMedicineChildren’sTransportProgramintegratedtelemedicineintotransportrequest.

*  Assistsbirthingcentersinthestabilizationofcriticallycaresickinfantwhiletransportisenroute.

*  Providesfamilycenteredcare.

WVUMedicineChildren’sTransportTeam&Telemedicine

*  31weeksgestationalage*  Significantrespiratorydistresssyndrome,whorequiredimmediateventilatorassistanceandtransfertoNICU.*  Hazardousroadconditionsduetosnowstorm.*  TelemedicineequipmentassistedNICUteamtoassessinfant’scolor,perfusion,vitalsigns,chestradiographsandcomplianceloopsontheventilator.*  Assistedstabilizationatreferringcenter.*  Infantwastransferredonceweatherconditionimproved.*  Outcome:TheinfantrequiredventilatorsupportfortwodaysonlyandhospitalLOSwaslessthantwomonthsinourNICU.

CaseStudy1

*  Telemedicineprovedtobeaneffectivetooltoimprovecommunication,patientcareandultimatelyimproveoutcomesofpatientswithutmostsafetyofpatientandtransportcrew.*  Abilityfortertiarycareandcommunityhospitalstoutilizetelemedicineintheneonatalandpediatrictransportrequests

AdvantagesofTelemedicine

*  Cost*  Infrequencyofuse*  Proficiency/Education*  Portability

Barriers

*  Toimproveoutcomesformothersandbabiesthrougheducationalprogramsandqualityimprovementactivitiesforregionalperinatalcareproviders.*  CollaborationwiththeDivisionofNeonatology,Maternal-FetalMedicineandMDTVtooffereducationtoprovidersinlevelIandIIperinatalcenters.

PerinatalOutreachEducation

*  Thereislimiteddataaboutuseofsimulationduringthegoldenhourtoimproveoutcomes

*  HelpingBabiesBreatheStudy

Statistics

*  PromotesTeamwork*  Teamsutilizethesameequipmentandsupplies

*  DevelopsCommunicationSkills

*  ImprovesConfidence

*  ImprovesPerformance

*  ImprovesOutcomes

*  Safety

BenefitsofSimulation

ThisisBabyHal

*  LoanedtousbyWVPerinatalPartnership

*  Purchasedamonitor

*  WVUStepshelpedourteamwiththesoftwareapplication

*  Perinataloutreachsimulationtoimprovingoutcomes

*  Perinataleducationteamutilizessimulationbasedcasescenariosonoptimizationofthecareduringgoldenhour.Perinataleducationteamhasrecentlyintegrateddistantlearningviauseofsimulationandtelemedicine.

InSummary

SpecialThanks

*  WVPerinatalPartnership*  WVUSteps*  StaffatGrantMemorialHospital*  MDTV*  CindyBarnes,MDTVProgram

Manager*  DonovanMonday,MDTV/ITCSS

Unityisstrength…whenthereisteamworkandcollaboration,

wonderfulthingscanbeachieved.

MattieStepanek

*  InsertPicture

PerinatalOutreachTeam