As hospital consolidation continues nationwide, rural areas are beginning to take a new shape – and it is not a pretty picture.
According to a recent study from Health Affairs, newly acquired rural hospitals are eliminating surgical care services and mental health treatment access, despite a sharp rise in depression, suicide and addiction in the hard-hit rural communities.
Even more stunning, these newly acquired hospitals are more likely to eliminate maternity and neonatal care than those that remain independent. Coupled with a worsening nursing shortage, this is a huge problem for rural American families.
Even before the pandemic, maternal and infant outcomes in the U.S. were shockingly poor. The Agency for Healthcare Research and Quality reported the number of women experiencing severe issues while giving birth in U.S. hospitals rose 45% from 2006 to 2015.
Add to that the fact that the United States still has one of the highest maternal death rates among the world's developed nations, and this becomes an overlooked crisis that needs solutions – one that may be getting worse, given the Health Affairs study.
Chief nursing officer at maternity and neonatal care health IT company PeriGen and former labor-and-delivery nurse Alana McGolrick, DNP, has studied the issue in-depth – from the business hurdles, to the labor shortage, to the larger systemic issues with access in rural areas – and strategies that can be deployed to improve the situation. These strategies include telemedicine and remote patient monitoring.
Healthcare IT News sat down with McGolrick to learn what she learned by studying these issues.
Q. Please describe the status of maternity and neonatal care in rural United States today.
A. Nationally, our pregnant patients are facing several unknowns related to healthcare access and the uncertainty that the current pandemic has created.
With rising national maternal morbidity and mortality rates, the pregnant patient must navigate through the complexities of what was previously considered a state of wellness while safeguarding her own health, as well as the developing fetus. Adding to these challenges, access to perinatal services in the rural setting has created a vulnerability for this special patient population.
Recent literature has shown that the rural pregnant patient can be at higher risk for developing complications associated with pregnancy due to length of travel to appropriate facilities, delay in accessing perinatal care and individual chronic health conditions.
The most recent data gathered in 2015 indicates that the pregnancy-related mortality ratio is 29.4 out of 100,000 live births, compared with 18.2 in urban areas. Additionally, it is reported that 54% of rural counties lack perinatal hospital services and 120 rural county hospitals have closed their doors permanently.
Q. What role can remote patient monitoring and telehealth play in helping with rural maternity and neonatal care?
A. The loss of services in the rural setting has prompted healthcare leaders to utilize alternatives when caring for this special patient population. Remote patient monitoring is the most recent intervention in healthcare delivery to address access to appropriate levels of care and services.
The utilization of remote patient monitoring has shown early success in the perinatal space. The ability to "see" the maternal-fetal dyad from a remote location has provided a layer of protection for the patient and the providers. Due to the unpredictable nature of a laboring patient, a pregnant woman cannot be expected to travel 50 miles for care.
Implementing a remote patient monitoring model allows the larger healthcare center to monitor the smaller rural or critical care access hospital, tracking [its] progress and working in a consultative role with the clinicians at the bedside. Powered by artificial intelligence, the remote patient monitoring system is able to review maternal vital sign trends, fetal heart rate pattern and uterine activity.
Q. You've said that artificial intelligence can be used to identify unseen risks or worsening conditions in patients that rural hospitals may be unequipped to deal with. Please elaborate on this.
A. Remote patient monitoring, powered by artificial intelligence, provides valuable benefits for the patient, the clinician at the bedside and the clinicians in the remote monitoring center.
First, the patient gains a team of experts who are watching from a remote location, ensuring that any issues or concerns will be identified and not experience delay in care. Second, the smaller hospitals can instantly gain access to the experience of the nurses and physicians in the large hospital and can consult with these experts to coordinate the patient's plan of care.
Finally, the system is designed to identify negative trends as they develop, and in some cases before the human eye can detect a worsening condition. Additionally, the system has the ability to filter at-risk patients to the top of the list, drawing the attention of the staff to the patients that are experiencing abnormalities.
Q. How else can healthcare information technology play a role in buttressing rural maternity and neonatal care?
A. Healthcare information technology can address other concerns that the perinatal service line is experiencing. Challenges include the national staffing shortage and the lack of access to sophisticated information technology services.
Providing a partnership between the smaller hospitals and larger centers enables the smaller hospital to ensure proper staffing and coverage during vulnerable shifts, such as the night shift. The staffing shortage has also led to the more inexperienced staff providing care to the perinatal patient.
With remote patient monitoring, there will always be an experienced staff person continuously monitoring the patient in a consultative role. This is another layer of protection for the patient and her fetus. Ultimately, this cohesive relationship between the rural hospital and larger center would bridge the gap between safe and appropriate access to perinatal services for individuals living in rural areas.
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