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

Arch Gynecol Obstet. 2012 Dec;286(6):1383-92. doi: 10.1007/s00404-012-2465-5. Epub 2012 Jul 21.

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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Arkansas
  • Chi-Square Distribution
  • Family Practice / statistics & numerical data
  • Family Practice / trends
  • Female
  • Government Agencies / statistics & numerical data
  • Government Agencies / trends
  • Humans
  • Local Government
  • Medicaid / statistics & numerical data
  • Multivariate Analysis
  • Obstetrics / trends*
  • Patient Care / statistics & numerical data
  • Patient Care / trends
  • Patient Care Team / trends
  • Practice Guidelines as Topic
  • Pregnancy
  • Pregnancy Complications / diagnosis
  • Pregnancy Complications / therapy*
  • Pregnancy, High-Risk
  • Referral and Consultation / statistics & numerical data
  • Referral and Consultation / trends*
  • Rural Health Services / statistics & numerical data
  • Rural Health Services / trends*
  • Telemedicine / statistics & numerical data
  • Telemedicine / trends*
  • United States
  • Young Adult