Maternal-Fetal Medicine in Crisis
Editor’s Note: Sg2 Director Karyl Kopaski, PhD, contributed to this special Women’s Health edition of the Virtual Health Newsletter.
Maternal-Fetal Medicine in Crisis
For too long, the United States has failed in its mandate to keep women safe: the country is facing a crisis of inadequate care for pregnant women. Several factors contribute to the often tenuous state of pregnant women’s health, particularly for those in rural or disadvantaged socioeconomic communities. Shortages of obstetricians and gynecologists (ob/gyns) have reached critical levels, with half of US counties lacking a single ob/gyn, according to the American College of Obstetricians and Gynecologists. Those counties represent more than 10 million women who need ob/gyns for primary care. Furthermore, by 2020, there will be 8,000 fewer women’s health specialists than needed.
The prevailing financial realities of operating a labor and delivery unit are another contributing factor. Many local community hospitals across the country have closed their units, and for those that remain open, the community-based physicians may be ill-prepared to handle the complexity of births due to their relative infrequency, creating a dangerous environment for pregnant women. In the wake of the closures, the risks associated with pregnant patients have often shifted to the ED.
The provision of ongoing care throughout pregnancy has been shown to decrease complications, and several organizations have turned to virtual health technologies to improve access to care for pregnant women.
Virtual Health Supports Pregnant Women in Need
For high-risk pregnancy patients, access to specialists is critical. In recent years, patients in select areas where this specialty care generally is not available have been able to receive virtual prenatal visits and reviews of ultrasounds, and remote patient monitoring when appropriate, via tele-consults. The Medical University of South Carolina (MUSC) and the University of Arkansas for Medical Sciences are just 2 examples of organizations that offer this specialty care to rural and low-socioeconomic-status patients across South Carolina and Arkansas, respectively.
MUSC and the University of Arkansas Medical Center’s ANGELS program use tele-consults to meet the needs of underserved communities experiencing shortages of maternal-fetal medicine (MFM) providers. In doing so, they have reduced premature births and both neonatal and maternal mortality for patient populations with high rates of diabetes and hypertension.
Even more rudimentary technology-based interventions can impact mortality rates and provide value. In a recent study of text-based interventions for postpartum care, patients were asked to text in their blood pressure measurements in lieu of coming in for a postpartum office visit. The study, focused on black women, demonstrated that disparities between nonblack patients and black patients were eliminated among those who utilized the texting app. This finding has broad implications, as black women experience disproportionately high rates of maternal mortality compared to white and nonblack women.
Virtual health can also provide value for low-risk pregnancies. Patients in areas where access to care is challenging receive and are trained to use remote monitoring peripherals to track fetal heart rate, maternal blood pressure and fundal height. This approach to providing virtual prenatal care has been shown to produce similar pregnancy outcomes to those for women who have traditional in-person prenatal care.
Finally, virtual health technologies are being used to not only support care delivery but also perhaps solve the greater challenge of serving pregnant women in need. Through a $1.2 million National Science Foundation Smart and Connected Health grant, the University of Texas is launching an initiative to track 1,000 pregnant women utilizing an mHealth app. The remote monitoring initiative hopes to gain an understanding of why American maternal mortality rates are among the worst in the developed world.
As your organization seeks to establish virtual health programs to improve access to maternal-fetal care:
- Establish partnerships for success. Whether you are an organization with MFM resources or an organization in need of them, virtual health can serve as the foundation of a partnership to increase access to these services.
- Seek opportunities to invest in women’s health in general. These may be loss leaders but are aligned with organizations’ missions and may provide value downstream in a variety of ways.
- Analyze organizational data to investigate your organization’s areas of opportunity related to women’s health where virtual health can provide value.
Executing on these strategies can be challenging. Need additional support and guidance? We can help! We offer market-leading expertise and consulting services that can support you in further developing your virtual women’s health program to support patients at all points of maternity.
Questions or Comments?
Have specific questions or want to learn more about how Sg2 can support your virtual health initiatives? Contact me at 847.779.5449 or cpagano@sg2.com.
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Tags: high-risk pregnancy, maternal-fetal medicine, MFM, mHealth, remote monitoring, tele-consults, text-based interventions, virtual health