From U Arkansas: Evolving trends in maternal fetal medicine referrals in a rural state using telemedicine

http://www.ncbi.nlm.nih.gov/pubmed/22821508

Arch Gynecol Obstet. 2012 Jul 21. [Epub ahead of print]

Evolving trends in maternal fetal medicine referrals in a rural state using telemedicine.

Magann EF, Bronstein J, McKelvey SS, Wendel P, Smith DM, Lowery CL.

Source

Department of Obstetrics and Gynecology, University of Arkansas for the Medical Sciences, 4301 W. Markham Street, Slot # 518, Little Rock, AR, 72205, USA, efmagann@uams.edu.

Abstract

OBJECTIVE:

To determine maternal fetal medicine (MFM) referral trends in a Medicaid population over time.

STUDY DESIGN:

Sixteen clinical guidelines and 23 clinical conditions were identified where co-management/consultation with MFM specialist is recommended. Linked Medicaid claims and birth certificate data for 2001-2006 were used to identify pregnancies with these conditions and whether they received co-management/consultation from a MFM specialist.

RESULTS:

Between 2001 and 2006, there were 108,703 pregnancies with delivery of 110,890 neonates. Forty-five percent had one or more of the conditions identified for co-management/consultation. Overall pregnancies receiving MFM contact remained unchanged at 22.2 % in 2001 and 22.1 % in 2006. However, face to face contacts decreased from 14.6 % (2001) to 8.7 % (2006) while telemedicine consults increased from 7.6 % (2001) to 13.3 % (2006). Health departments were most likely and family practitioners least likely to refer to MFM (p < 0.001). Pregnancy complications leading to MFM referrals include cardiac complications, renal disease, systemic disorders, PPROM, suspected fetal abnormalities, and cervical insufficiency.

CONCLUSION:

Referral of high-risk pregnancies to MFMs varies with the level of expertise at the primary prenatal site. Increased contact between MFMs and local providers increased MFM referrals.