Absorbing and transferring risk: assessing the impact of a statewide high-risk-pregnancy telemedical program on VLBW maternal transportsReport as inadecuate




Absorbing and transferring risk: assessing the impact of a statewide high-risk-pregnancy telemedical program on VLBW maternal transports - Download this document for free, or read online. Document in PDF available to download.

BMC Pregnancy and Childbirth

, 6:11

First Online: 04 April 2006Received: 05 August 2005Accepted: 04 April 2006

Abstract

BackgroundPrior research has shown that resources have an impact on birth outcomes. In this paper we ask how combinations of telemedical and hospital-level resources impact transports of mothers expecting very low birth weight VLBW babies in Arkansas.

MethodsUsing de-identified birth certificate data from the Arkansas Department of Health, data were gathered on transports of women carrying VLBW babies for two six-month periods: a period just before the start of ANGELS 12-02-05-03, a telemedical outreach program for high-risk pregnancies, and a period after the program had been running for six months 12-03-05-04. For each maternal transport, the following information was recorded: maternal race-ethnicity, maternal age, and the birth weight of the infant. Logistic regression was used to assess the relationship between the predictors telemedicine, hospital level, maternal characteristics and the probability of a transport.

ResultsHaving a telemedical site available increases the probability of a mother carrying a VLBW baby being transported to a level III facility either before or during birth. Having at least a level II nursery also increases the chance of a maternal transport. Where both level II nurseries and telemedical access are available, the odds of VLBW maternal transports are only modestly increased in comparison to the case where neither is present. At the individual level, Hispanic mothers were less likely to be transported than other mothers, and teenaged mothers were more likely to be transported than those 18 and over. A mother-s being Black or being over 35 did not have an impact on the odds of being transported to a level III facility.

ConclusionCombinations of resources have an impact on physician decisions regarding VLBW transports and are interpretable in terms of the capacity to diagnose and absorb risk. We suggest a collegial review of transport patterns and birth outcomes from areas with different levels of resources as a vehicle for moving the entire system of care forward over time. With such an evidence-based review in place, the collegial relations among level III specialists and obstetricians from around the state can, over time, develop workable protocols for when and how level III facilities should be involved.

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Author: David W Britt - Janet Bronstein - Jonathan D Norton

Source: https://link.springer.com/



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