Mayo Clinic Center for Clinical and Translational Science (CCaTS UL1 Supplement - Dr. Regan Theiler)

项目摘要 背景资料：近几十年来，美国孕产妇死亡率的惊人增长使 在提供安全的产妇保健方面，这个国家在工业化国家中垫底。一些人 已经确定了潜在的风险因素，包括不成比例的产妇死亡率负担 有色人种妇女、产妇高龄妇女和生活在服务不足地区的妇女。人才的短缺 农村地区的妇产科医生和妇产科医生都使许多地区得不到任何产科护理 供应商都不是。由于这个问题的多因素原因，寻求扭转这一趋势的计划 不断增加的孕产妇死亡率必须同时解决与不利因素相关的个人和系统风险因素 母性结局。 目标：该项目的目标是测试同步、远程 远程医疗产科计划为急诊科和小型分娩单位提供服务 美国中西部的医院。 方法：将在20个急诊科和10个劳动和医疗保健部门实施急性TeleOB计划 梅奥诊所卫生系统中的交付单位，为WI、MN和IA提供服务。使用实时高清 音频/视频接口，四级产科病房的TeleOB顾问将指导非产科医生通过 采取必要措施稳定出现产科紧急情况的患者，包括出血、感染、 创伤和心血管事件。由于孕产妇死亡率较低，严重的孕产妇 发病率将被用作不良孕产妇结局的替代“险些”标记。与服务并行 激活，将建立卫生系统中出生人口的全面数据库(每年10,000英镑)，以允许 妇幼保健政策实施前后重度孕产妇发病率及病种比较 TeleOB咨询服务。该数据库还将被用来将不良孕产妇结局与 健康的医疗和社会决定因素，目的是确定孕产妇死亡的可改变的风险因素 与每个社区最相关的发病率和死亡率。社区咨询委员会将是 受聘于规划服务实施，并传播研究得出的任何针对社区的结果。 影响：如果TeleOB服务在帮助关键接入设施和其他小型 医院为稳定出现产科紧急情况的患者，该计划将传播到其他 服务不足的地区，并提供更多的卫生系统。干预的可扩展性使其 作为减少地域不平等和让美国所有女性获得高质量的机会的一种手段，具有吸引力 紧急产科护理。

Project Summary Background: Startling increases in the rate of maternal mortality in the United States over recent decades put the country at the bottom of industrialized nations when it comes to provision of safe maternity care. Some underlying risk factors have been identified, including a disproportionate burden of maternal mortality among women of color, women of advanced maternal age, and women living in underserved areas. The shortage of both maternity units and Ob/Gyn physicians in rural areas has left many areas without any maternity care providers at all. Because of the multifactorial etiology of the problem, programs seeking to reverse the trend of increasing maternal mortality must address both individual and systemic risk factors associated with adverse maternal outcomes. Objective: The objective of this project is to test the feasibility and safety of a synchronous, remote telemedicine Obstetrics program serving emergency departments and labor and delivery units at small hospitals in the Midwestern United States. Approach: Acute teleOB programs will be implemented at 20 emergency departments and 10 labor and delivery units in the Mayo Clinic Health System, which serves WI, MN, and IA. Using a real-time HD audio/video interface, TeleOB consultants at the level IV maternity unit will guide non-obstetricians through the necessary steps to stabilize patients presenting with obstetric emergencies including hemorrhage, infection, trauma, and cardiovascular events. Because of the low incidence of maternal mortality, severe maternal morbidity will be used as a surrogate “near miss” marker of adverse maternal outcomes. In parallel with service activation, a comprehensive database of births in the Health System (>10,000 per year) will be built to allow comparison of rates and categories of severe maternal morbidity before and after implementation of the TeleOB consultation service. The database will also be used to associate adverse maternal outcomes with medical and social determinants of health, with the goal of identifying modifiable risk factors for maternal morbidity and mortality that are most relevant for each community. Community advisory boards will be engaged to plan service implementation and to disseminate any community-specific findings from the study. Impact: If the TeleOB service demonstrates effectiveness in helping critical access facilities and other small hospitals to stabilize patients presenting with obstetric emergencies, the program will be disseminated to other underserved regions and offered to additional health systems. The scalability of the intervention makes it attractive as a means to reduce geographic inequities and give all women in the U.S. access to high quality emergency obstetric care.