Abstract
Objective
To determine maternal fetal medicine (MFM) referral trends in a Medicaid population over time.
Study design
Sixteen clinical guidelines and 23 clinical conditions were identified where co-management/consultation with MFM specialist is recommended. Linked Medicaid claims and birth certificate data for 2001–2006 were used to identify pregnancies with these conditions and whether they received co-management/consultation from a MFM specialist.
Results
Between 2001 and 2006, there were 108,703 pregnancies with delivery of 110,890 neonates. Forty-five percent had one or more of the conditions identified for co-management/consultation. Overall pregnancies receiving MFM contact remained unchanged at 22.2 % in 2001 and 22.1 % in 2006. However, face to face contacts decreased from 14.6 % (2001) to 8.7 % (2006) while telemedicine consults increased from 7.6 % (2001) to 13.3 % (2006). Health departments were most likely and family practitioners least likely to refer to MFM (p < 0.001). Pregnancy complications leading to MFM referrals include cardiac complications, renal disease, systemic disorders, PPROM, suspected fetal abnormalities, and cervical insufficiency.
Conclusion
Referral of high-risk pregnancies to MFMs varies with the level of expertise at the primary prenatal site. Increased contact between MFMs and local providers increased MFM referrals.
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Acknowledgments
We acknowledge the support and assistance of the Arkansas Center for Clinical and Translational Research 5UL1RR029884-02/5KL2RR029883-02, 07/14/2009–03/31/2014 NIH/NCRR.
Conflict of interest
We declare that we have no conflict of interest.
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Magann, E.F., Bronstein, J., McKelvey, S.S. et al. Evolving trends in maternal fetal medicine referrals in a rural state using telemedicine. Arch Gynecol Obstet 286, 1383–1392 (2012). https://doi.org/10.1007/s00404-012-2465-5
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DOI: https://doi.org/10.1007/s00404-012-2465-5