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      Evaluation of Neonatal Services Provided in a Level II NICU Utilizing Hybrid Telemedicine: A Prospective Study

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          Abstract

          Objective: To evaluate the safety and efficacy of premature infant treatment managed by hybrid telemedicine versus conventional care.

          Methods: Prospective, noninferiority study comparing outcomes of premature infants at Comanche County Memorial Hospital's (CCMH) Level II neonatal intensive care unit (NICU) with outcomes at OU Medical Center's (OUMC) Level IV NICU. All 32–35 weeks gestational age (GA) infants admitted between May 2015 and October 2017 were included. Infants requiring mechanical ventilation >24 h or advanced subspecialty care were excluded. Outcome variables were: length of stay (LOS), respiratory support, and time to full per oral (PO) feeds. Parents at both centers were surveyed about their satisfaction with the care provided. Between-group comparisons were performed by using Chi-square or Fisher's exact test. LOS was assessed for normality by using the Shapiro–Wilk test, and robust regression was used to construct a multivariable regression model to test the independent effect of location on LOS. All analyses were performed by using SAS v. 9.3 (SAS Institute, Cary, NC).

          Results: Data from 85 CCMH and 70 OUMC neonates were analyzed. CCMH neonates had significantly shorter LOS, reached full PO feeds sooner, and had fewer noninvasive ventilation support days. Location had a significant independent effect (p = 0.001) on LOS while controlling for GA, gender, race, surfactant use, inborn/outborn status, and 5-min APGAR scores. CCMH patients had reduced LOS of 3.01 days (95% confidence interval 1.1–4.8) than OUMC patients. Eighty-five surveys at CCMH and 66 at OUMC were analyzed. Compared with CCMH, OUMC parents reported more travel distance difficulties. 92.5% reported telemedicine experience as good or excellent, whereas 1.5% reported it as poor.

          Conclusion(s): Hybrid telemedicine is a safe and effective way to extend intensive neonatal care to medically underserved areas. Parental satisfaction with use of hybrid telemedicine is high and comparable to conventional care.

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          Births: Final Data for 2016.

          Joyce Martin, Brady E Hamilton, Michelle Osterman … (2018)
          This report presents 2016 data on U.S. births according to a wide variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.Descriptive tabulations of data reported on the birth certificates of the 3.95 million births that occurred in 2016 are presented. Data are presented for maternal age, live-birth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age also are shown. Trend data for 2010-2016 are presented for selected items. A total of 3,945,875 births were registered in the United States in 2016, down 1% from 2015. Compared with rates in 2015, the general fertility rate declined to 62.0 per 1,000 women aged 15-44. The birth rate for females aged 15-19 fell 9% in 2016. Birth rates declined for women in their 20s but increased for women intheir 30s and early 40s. The total fertility rate declined to 1,820.5 births per 1,000 women in 2016. The birth rate for unmarried women declined, while the rate for married women increased. More than three-quarters of women began prenatal care in the firsttrimester of pregnancy (77.1%) in 2016, while 7.2% of all women smoked during pregnancy. The cesarean delivery rate declined for the fourth year in a row. Medicaid was the source of payment for 42.6% of all 2016 births. The preterm birth rate rose for the second straight year, and the rate of low birthweight increased 1%. Twin and triplet and higher-order multiple birth rates declined, although the changes were not statistically significant.
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            Intensive care unit telemedicine: alternate paradigm for providing continuous intensivist care.

            M Breslow, Daniel Anderson, Amy Rosenfeld … (2000)
            Intensive care units (ICUs) account for an increasing percentage of hospital admissions and resource consumption. Adverse events are common in ICU patients and contribute to high mortality rates and costs. Although evidence demonstrates reduced complications and mortality when intensivists manage ICU patients, a dramatic national shortage of these specialists precludes most hospitals from implementing an around-the-clock, on-site intensivist care model. Alternate strategies are needed to bring expertise and proactive, continuous care to the critically ill. We evaluated the feasibility of using telemedicine as a means of achieving 24-hr intensivist oversight and improved clinical outcomes. Observational time series triple cohort study. A ten-bed surgical ICU in an academic-affiliated community hospital. All patients whose entire ICU stay occurred within the study periods. A 16-wk program of continuous intensivist oversight was instituted in a surgical ICU, where before the intervention, intensivist consultation was available but there were no on-site intensivists. Intensivists provided management during the intervention using remote monitoring methodologies (video conferencing and computer-based data transmission) to obtain clinical information and to communicate with on-site personnel. To assess the benefit of the remote management program, clinical and economic performance during the intervention were compared with two 16-wk periods within the year before the intervention. ICU and hospital mortality (observed and Acute Physiology and Chronic Health Evaluation III, severity-adjusted), ICU complications, ICU and hospital length-of-stay, and ICU and hospital costs were measured during the 3 study periods. Severity-adjusted ICU mortality decreased during the intervention period by 68% and 46%, compared with baseline periods one and two, respectively. Severity-adjusted hospital mortality decreased by 33% and 30%, and the incidence of ICU complications was decreased by 44% and 50%. ICU length of stay decreased by 34% and 30%, and ICU costs decreased by 33% and 36%, respectively. The cost savings were associated with a lower incidence of complications. Technology-enabled remote care can be used to provide continuous ICU patient management and to achieve improved clinical and economic outcomes. This intervention's success suggests that remote care programs may provide a means of improving quality of care and reducing costs when on-site intensivist coverage is not available.
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              Regional Variation in Neonatal Intensive Care Admissions and the Relationship to Bed Supply

              David C Goodman, Jared R. Wasserman, Wade Harrison (2018)
              Article 0 comments Cited 31 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Telemed J E Health
                Journal ID (iso-abbrev): Telemed J E Health
                Journal ID (publisher-id): tmj
                Title: Telemedicine Journal and e-Health
                Publisher: Mary Ann Liebert, Inc., publishers (140 Huguenot Street, 3rd FloorNew Rochelle, NY 10801USA )
                ISSN (Print): 1530-5627
                ISSN (Electronic): 1556-3669
                Publication date (Print): February 2020
                Publication date (Electronic): 05 February 2020
                Publication date PMC-release: 05 February 2020
                Volume: 26
                Issue: 2
                Pages: 176-183
                Affiliations
                [1]Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
                Author notes
                [*]Address correspondence to: Abhishek Makkar, MD, Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, 1200 N Everett Drive, Oklahoma City, OK 73104-5410 abhishek-makkar@ 123456ouhsc.edu drabhishekmakkar@ 123456gmail.com
                Article
                Publisher ID: 10.1089/tmj.2018.0262
                DOI: 10.1089/tmj.2018.0262
                PMC ID: 7044771
                PubMed ID: 30835166
                SO-VID: 8b1bcdcf-acd7-4088-81ac-5d60f89ae5be
                Copyright © © Abhishek Makkar et al. 2019; Published by Mary Ann Liebert, Inc.
                License:

                This Open Access article is distributed under the terms of the Creative Commons License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : Received: October 9, 2018
                Date revision received : Revised: January 15, 2019
                Date accepted : Accepted: January 20, 2019
                Page count
                Figures: 4, Tables: 4, References: 26, Pages: 8
                Categories
                Subject: Original Research

                Keywords: telemedicine,pediatrics,e-health,telehealth,telecommunications,nicu
                Data availability:
                Keywords: telemedicine, pediatrics, e-health, telehealth, telecommunications, nicu

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