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

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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.