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Telemedicine collaboration improves perinatal regionalization and lowers statewide infant mortality

Abstract

Objective:

We assessed a telemedicine (TM) network’s effects on decreasing deliveries of very low birth weight (VLBW, <1500 g) neonates in hospitals without Neonatal Intensive Care Units (NICUs) and statewide infant mortality.

Study design:

This prospective study used obstetrical and neonatal interventions through TM consults, education and census rounds with 9 hospitals from 1 July 2009 to 31 March 2010. Using a generalized linear model, Medicaid data compared VLBW birth sites, mortality and morbidity before and after TM use. Arkansas Health Department data and χ2 analysis were used to compare infant mortality.

Result:

Deliveries of VLBW neonates in targeted hospitals decreased from 13.1 to 7.0% (P=0.0099); deliveries of VLBW neonates in remaining hospitals were unchanged. Mortality decreased in targeted hospitals (13.0% before TM and 6.7% after TM). Statewide infant mortality decreased from 8.5 to 7.0 per 1000 deliveries (P=0.043).

Conclusion:

TM decreased deliveries of VLBW neonates in hospitals without NICUs and was associated with decreased statewide infant mortality.

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Acknowledgements

We acknowledge the contributions of Arkansas Medicaid as a source of data in this publication, the Arkansas Department of Health, especially John Senner PhD and Shalini Manjanatha, and to P20 GM103425 (RWH). We also acknowledge Dr Janet Bronstein for her work on this project. We also thank the members of our research committee: Dr Curtis Lowery, David Fletcher, Tina Benton, Julie Hall-Barrow, Shannon Lewis, Stacy Pitsch, Lori Heil and Sarah Rhoads. We would like to recognize the obstetric and neonatal physicians, nurses and support staff of the participating hospitals, whose dedication made this program possible. This study was supported by a Centers for Medicare and Medicaid Service Transformation Grant (contract 4600016735), P20 GM103425 (RWH) and ANGELS.

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Correspondence to E W Kim.

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Kim, E., Teague-Ross, T., Greenfield, W. et al. Telemedicine collaboration improves perinatal regionalization and lowers statewide infant mortality. J Perinatol 33, 725–730 (2013). https://doi.org/10.1038/jp.2013.37

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