title: Evolving trends in maternal fetal medicine referrals in a rural state using telemedicine.
abstract: OBJECTIVE
  To determine maternal fetal medicine (MFM) referral trends in a Medicaid population over time.
  
  
  METHODS
  Sixteen clinical guidelines and 23 clinical conditions were identified where co-management/consultation with MFM specialist is recommended. Linked Medicaid claims and birth certificate data for 2001-2006 were used to identify pregnancies with these conditions and whether they received co-management/consultation from a MFM specialist.
  
  
  RESULTS
  Between 2001 and 2006, there were 108,703 pregnancies with delivery of 110,890 neonates. Forty-five percent had one or more of the conditions identified for co-management/consultation. Overall pregnancies receiving MFM contact remained unchanged at 22.2% in 2001 and 22.1% in 2006. However, face to face contacts decreased from 14.6% (2001) to 8.7% (2006) while telemedicine consults increased from 7.6% (2001) to 13.3% (2006). Health departments were most likely and family practitioners least likely to refer to MFM (p<0.001). Pregnancy complications leading to MFM referrals include cardiac complications, renal disease, systemic disorders, PPROM, suspected fetal abnormalities, and cervical insufficiency.
  
  
  CONCLUSIONS
  Referral of high-risk pregnancies to MFMs varies with the level of expertise at the primary prenatal site. Increased contact between MFMs and local providers increased MFM referrals.
authors: Department of Obstetrics and Gynecology, University of Arkansas for the Medical Sciences, 4301 W. Markham Street, Slot # 518, Little Rock, AR 72205, USA. efmagann@uams.edu
authors: Everett F
authors: EF
authors: Magann
authors: Janet
authors: J
authors: Bronstein
authors: Samantha S
authors: SS
authors: McKelvey
authors: Paul
authors: P
authors: Wendel
authors: Dora M
authors: DM
authors: Smith
authors: Curtis L
authors: CL
authors: Lowery
mesh_terms: D000293:Adolescent; D000328:Adult; D001131:Arkansas; D016009:Chi-Square Distribution; D005194:Family Practice / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006077:Government Agencies / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D009111:Local Government; D008484:Medicaid / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D009774:Obstetrics / Q000639:trends*; D005791:Patient Care / Q000706:statistics & numerical data / Q000639:trends; D010348:Patient Care Team / Q000639:trends; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000628:therapy*; D018566:Pregnancy, High-Risk; D012017:Referral and Consultation / Q000706:statistics & numerical data / Q000639:trends*; D019035:Rural Health Services / Q000706:statistics & numerical data / Q000639:trends*; D017216:Telemedicine / Q000706:statistics & numerical data / Q000639:trends*; D014481:United States; D055815:Young Adult