title: Moving beyond silos: How do we provide distributed personalized medicine to pregnant women everywhere at scale? Insights from PRE-EMPT.
abstract: While we believe that pre-eclampsia matters-because it remains a leading cause of maternal and perinatal morbidity and mortality worldwide-we are convinced that the time has come to look beyond single clinical entities (e.g. pre-eclampsia, postpartum hemorrhage, obstetric sepsis) and to look for an integrated approach that will provide evidence-based personalized care to women wherever they encounter the health system. Accurate outcome prediction models are a powerful way to identify individuals at incrementally increased (and decreased) risks associated with a given condition. Integrating models with decision algorithms into mobile health (mHealth) applications could support community and first level facility healthcare providers to identify those women, fetuses, and newborns most at need of facility-based care, and to initiate lifesaving interventions in their communities prior to transportation. In our opinion, this offers the greatest opportunity to provide distributed individualized care at scale, and soon.
authors.affiliation: Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada. Electronic address: pvd@cw.bc.ca.
authors.forename: Peter
authors.initials: P
authors.lastname: von Dadelszen
authors.affiliation: Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Magee
authors.affiliation: Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Payne
authors.affiliation: Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada; Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Dustin T
authors.initials: DT
authors.lastname: Dunsmuir
authors.affiliation: Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Sharla
authors.initials: S
authors.lastname: Drebit
authors.affiliation: Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada; Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Guy A
authors.initials: GA
authors.lastname: Dumont
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences and Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA.
authors.forename: Suellen
authors.initials: S
authors.lastname: Miller
authors.affiliation: University of Edinburgh/MRC Centre for Reproductive Health, The Queen's Medical Research Institute, University of Edinburgh, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Norman
authors.affiliation: Family Health Team, Bill & Melinda Gates Foundation, USA; Department of Global Health, University of Washington, Seattle, WA, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Pyne-Mercier
authors.affiliation: Division of Women's Health, King's College London, London, UK.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Shennan
authors.affiliation: Family Health Team, Bill & Melinda Gates Foundation, USA.
authors.forename: France
authors.initials: F
authors.lastname: Donnay
authors.affiliation: Centre for Global Child Health, Hospital for Sick Children, University of Toronto, Toronto, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
authors.affiliation: Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada; Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada.
authors.forename: J Mark
authors.initials: JM
authors.lastname: Ansermino
mesh_terms: D000328:Adult; D000465:Algorithms; D020000:Decision Support Systems, Clinical; D005260:Female; D006268:Health Facilities; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services; D011225:Pre-Eclampsia / Q000401:mortality / Q000628:therapy*; D057285:Precision Medicine / Q000379:methods*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality / Q000628:therapy*; D018570:Risk Assessment / Q000379:methods; D017216:Telemedicine
keywords: Maternal health; Mobile health; Newborn health; Outcome prediction; PRE-EMPT; Stillbirth