Hall R Whit, Hall-Barrow Julie, Garcia-Rill Edgar
Center for Translational Neuroscience, Department of Pediatrics, Neonatology, University of Arkansas for Medical Sciences, USA.
Ethn Dis. 2010 Winter;20(1 Suppl 1):S1-136-40.
Although regionalization of neonatal intensive care is associated with improved outcomes, implementation has been difficult because of increased deliveries of sicker neonates in smaller nurseries. Telemedicine has been used successfully for medical care and education but it has never been utilized to modify patterns of delivery in an established state network.
The Community Based Research and Education Core Facility of the Center for Translational Neuroscience established a network of 15 telemedicine units with real-time teleconferencing and diagnostic quality imaging, called Telenursery, placed in neonatal intensive care units, using T1 lines to link these units with a large academic neonatal practice. Weekly educational conferences were conducted to establish guidelines for obstetrical, neonatal and pediatric care in a program called PedsPLACE (Physician Learning and Collaborative Education). Patterns of delivery were assessed through a linked Medicaid database before and after the Telenursery initiative to determine if the most at-risk neonates were transferred to the academic perinatal center for delivery. Clinician satisfaction with the PedsPLACE educational conference was high as assessed through written survey instruments.
Medicaid deliveries at the regional perinatal centers increased from 23.8% before the intervention to 33% in neonates between 500 and 999 grams (P < .05) and was unchanged in neonates between 2001-2500 grams.
Telemedicine is an effective way to translate evidence-based medicine into clinical care when combined with a general educational conference. Patterns of deliveries appear to be changing so that those newborns at highest risk are being referred to the regional perinatal centers.
尽管新生儿重症监护的区域化与改善预后相关，但由于较小的新生儿护理机构中病情较重的新生儿分娩数量增加，实施起来一直很困难。远程医疗已成功用于医疗护理和教育，但从未被用于改变既定州网络中的分娩模式。
转化神经科学中心的社区基础研究与教育核心设施建立了一个由15个远程医疗单元组成的网络，这些单元配备实时电话会议和诊断质量成像设备，称为远程托儿所，设置在新生儿重症监护病房，使用T1线路将这些单元与一个大型学术性新生儿诊疗机构相连。通过一个名为PedsPLACE（医师学习与合作教育）的项目，每周举行教育会议，以制定产科、新生儿科和儿科护理指南。在远程托儿所计划实施前后，通过链接的医疗补助数据库评估分娩模式，以确定风险最高的新生儿是否被转到学术性围产期中心分娩。通过书面调查问卷评估，临床医生对PedsPLACE教育会议的满意度很高。
区域围产期中心的医疗补助分娩率在干预前为23.8%，在体重500至999克的新生儿中增至33%（P<.05），而体重2001至2500克的新生儿的分娩率没有变化。
当与一般性教育会议相结合时，远程医疗是将循证医学转化为临床护理的有效方式。分娩模式似乎正在发生变化，风险最高的新生儿正被转诊至区域围产期中心。
