Kozhimannil, Katy B.

Objective: To implement use of obstetric (OB) hospitalist telemedicine services (TeleOB) to support clinicians facing OB emergencies in low-resource hospital settings. Methods: TeleOB was staffed by OB hospitalists working at a tertiary maternity center. The service was available via real-time high-definition audio/video technology for providers at 17 outlying hospitals across a health system spanning two states. The initial 25 service activations are described. Results: TeleOB supported 17 deliveries, two postpartum emergency department (ED) consultations, and four antenatal ED consultations. In 10 of 17 (59%) deliveries, teleneonatology was jointly activated to support neonatal resuscitation. Sixteen (94%) deliveries occurred in multiparas, and five (29%) resulted from spontaneous preterm labor. Eighty percent (20/25) of activations occurred in facilities without maternity services. Conclusions: A TeleOB service staffed by OB hospitalists successfully supports hospitals in an integrated health care system. TeleOB is feasible for support of hospitals with no delivery facilities or with limited maternity care resources.

AbstractBackgroundOne in nine US infants is born before 37 weeks' gestation, incurring medical costs 10 times higher than full‐term infants. One in three infants is born by cesarean; cesarean births cost twice as much as vaginal births. We compared rates of preterm and cesarean birth among Medicaid recipients with prenatal access to doula care (nonmedical maternal support) with similar women regionally. We used data on this association to mathematically model the potential cost‐effectiveness of Medicaid coverage of doula services.MethodsData came from two sources: all Medicaid‐funded, singleton births at hospitals in the West North Central and East North Central US (n = 65,147) in the 2012 Nationwide Inpatient Sample, and all Medicaid‐funded singleton births (n = 1,935) supported by a community‐based doula organization in the Upper Midwest from 2010 to 2014. We analyzed routinely collected, de‐identified administrative data. Multivariable regression analysis was used to estimate associations between doula care and outcomes. A probabilistic decision‐analytic model was used for cost‐effectiveness estimates.ResultsWomen who received doula support had lower preterm and cesarean birth rates than Medicaid beneficiaries regionally (4.7 vs 6.3%, and 20.4 vs 34.2%). After adjustment for covariates, women with doula care had 22 percent lower odds of preterm birth (AOR 0.77 [95% CI 0.61–0.96]). Cost‐effectiveness analyses indicate potential savings associated with doula support reimbursed at an average of $986 (ranging from $929 to $1,047 across states).ConclusionsBased on associations between doula care and preterm and cesarean birth, coverage reimbursement for doula services would likely be cost saving or cost‐effective for state Medicaid programs.