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

梅奥诊所临床和转化科学中心（CCaTS UL1 补充 - Regan Theiler 博士）

• 批准号: 10195445
• 负责人: Claudia F. Lucchinetti
• 金额: $ 24.97万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-18 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10195445
• 关键词: Accident and Emergency department; Acute; Address; American College of Obstetricians and Gynecologists; Area; Birth; Birthing Centers; Cardiovascular Diseases; Cardiovascular system; Caring; Categories; Cessation of life; Characteristics; Clinic; Clinical Sciences; Color; Communication; Communities; Community Health Systems; Consultations; Country; Databases; Developed Countries; Discipline of obstetrics; Disease; Effectiveness; Emergency Situation; Etiology; Event; Facility Accesses; Family Practice; Fright; Future; Geography; Goals; Health Personnel; Health care facility; Health system; Hemorrhage; Hospitals; Incidence; Indigenous; Individual; Infection; Infrastructure; Intervention; Leadership; Left; Life; Link; Maternal Mortality; Medical; Medical emergency; Midwestern United States; Minority; Monitor; Mothers; Nurse Midwives; Patients; Perinatal; Pharmaceutical Preparations; Physicians; Population; Postpartum Period; Pregnancy; Pregnancy Outcome; Pregnant Women; Provider; Research Personnel; Resources; Risk Factors; Rural; Rural Health; Rural Hospitals; Safety; Services; Site; Standardization; Surgeon; System; Techniques; Telemedicine; Testing; Time; Training; Translational Research; Trauma; Travel; United States; Woman; Work; advanced maternal age; adverse maternal outcomes; antenatal; biomedical referral center; care costs; care providers; clinical center; cost; critical access hospital; evidence base; expectation; health care delivery; improved; innovation; intrapartum; maternal condition; maternal health care; maternal morbidity; medical specialties; modifiable risk; novel; obstetric care; prevent; programs; response; rural area; rural underserved; safety and feasibility; safety study; severe maternal morbidity; social health determinants; symposium; trend

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.

项目总结