By KRISTI BIRCH
KU News Service
KANSAS CITY — The University of Kansas Medical Center has been awarded a four-year, nearly $4 million grant from the Health Resources and Services Administration (HRSA) to improve pregnancy and birth outcomes in rural Kansas. The grant is part of HRSA’s Rural Maternity and Obstetrics Management Strategies (RMOMs) program, which was created to increase access to quality maternal and obstetrics care in rural parts of the United States.
“Because Kansas is very rural, access to obstetrical care is a really pressing issue,” said Karen Weis, Ph.D., FAAN, professor of nursing at the University of Kansas School of Nursing-Salina, associate director of research for the Kansas Center for Rural Health, and the principal investigator on the HRSA grant.
“And some critical access hospitals (typically rural hospitals with no more than 25 beds) are either closing entirely or closing their obstetrical care, and it’s creating an issue with access to maternal health care.”
In the United States, a country that has among the highest maternal mortality and morbidity rates in the developed world, women in rural areas have a 9% greater chance of dying or suffering a severe health condition as a consequence of maternity compared with their urban counterparts, according to a study published in Health Affairs.
Infant mortality rates are 6% higher in rural American counties compared with small and medium-sized cities, and 20% higher than those in large metropolitan areas.
The grant will be used to pilot a sustainable model of quality obstetrical services and care at a network of three hospitals in counties in central and northwest Kansas that are part of the Sunflower Health Network: Mitchell County Hospital, Beloit, Sheridan County Health Complex, Goodland, and Smith County Memorial Hospital and Rural Family Practice, Smith Center.
A critical piece of the project will be building the teleradiology component.
Teleradiology, the transmission of radiologic images such as ultrasounds and X-rays from one location to another, allows radiologists to provide services to patients without being in the same location. This effort will be led by Brian Brost, M.D., and Marc Parrish, D.O., both professors of obstetrics and gynecology at KU School of Medicine with fellowship training in maternal-fetal medicine. Both also are co-investigators on the grant.
Teleradiology allows sonographers to be trained in obstetric ultrasonography remotely.
Obstetric ultrasonography, also known as prenatal ultrasound, is challenging because babies can be in different positions in the womb, and they often move during the ultrasound. However, sonography training typically includes just a couple of months focused on obstetrics. That’s why creating and conducting a remote training program in performing obstetric ultrasounds is an important feature of the project.
The training program will utilize a simulator machine known as ScanTrainer that will enable sonographers to train and practice in their own hospital over time, without having to travel, and Brost can review their work and offer feedback from Kansas City.
“This training is important, because if we get good images, if we get early identification of a fetal problem, we can get the patient to a higher level of care before bad things happen,” said Brost.
The grant also will be used to:
• Create a referral system to provide remote, virtual consultations with maternal-fetal medicine specialists using telemedicine and teleradiology.
• Develop system-wide review of high-risk patients.. Provide emergency obstetrics training for physicians, nurses and first responders.
• Devise protocols and policies in the network for maternal transports, blood sharing and staff sharing.
• Create nurse navigator positions within the network to coordinate care.. Establish long-term data management and sharing.
The success of the project will be measured by early and consistent prenatal care, reductions in the rate of low-birth weight babies and preterm births, and fewer maternal morbidities and decreased infant and maternal deaths.
Weis said that eventually, they hope to expand the network to include more rural Kansas hospitals that provide obstetrical services.
“The overall, arching outcome that RMOMs is trying to effect is a decrease in maternal mortality and morbidity through aggregated, coordinated, sustained risk-appropriate care,” said Weis. “So, we've included all these things to build a network and provide the best obstetric care we can in rural environments.”