Neonatal regionalization through telemedicine using a community-based research and education core facility.
BACKGROUND
Although regionalization of neonatal intensive care is associated with improved outcomes, implementation has been difficult because of increased deliveries of sicker neonates in smaller nurseries. Telemedicine has been used successfully for medical care and education but it has never been utilized to modify patterns of delivery in an established state network.


METHODS
The Community Based Research and Education Core Facility of the Center for Translational Neuroscience established a network of 15 telemedicine units with real-time teleconferencing and diagnostic quality imaging, called Telenursery, placed in neonatal intensive care units, using T1 lines to link these units with a large academic neonatal practice. Weekly educational conferences were conducted to establish guidelines for obstetrical, neonatal and pediatric care in a program called PedsPLACE (Physician Learning and Collaborative Education). Patterns of delivery were assessed through a linked Medicaid database before and after the Telenursery initiative to determine if the most at-risk neonates were transferred to the academic perinatal center for delivery. Clinician satisfaction with the PedsPLACE educational conference was high as assessed through written survey instruments.


RESULTS
Medicaid deliveries at the regional perinatal centers increased from 23.8% before the intervention to 33% in neonates between 500 and 999 grams (P < .05) and was unchanged in neonates between 2001-2500 grams.


CONCLUSIONS
Telemedicine is an effective way to translate evidence-based medicine into clinical care when combined with a general educational conference. Patterns of deliveries appear to be changing so that those newborns at highest risk are being referred to the regional perinatal centers.
Center for Translational Neuroscience, Department of Pediatrics, Neonatology, University of Arkansas for Medical Sciences, USA. hallrichardw@uams.edu
R Whit
RW
Hall
Julie
J
Hall-Barrow
Edgar
E
Garcia-Rill
D001131:Arkansas; D019317:Evidence-Based Medicine; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration*; D008484:Medicaid / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D009359:Neonatology / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000458:organization & administration; D017216:Telemedicine / Q000639:trends*; D014481:United States