Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Access to Provider through Hotline, HOSPITAL, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, STATE, Policy/Guideline (State), Consultation Systems (Inter-Hospital Systems), Consultation Systems (Hospital), Telemedicine Systems (Inter-Hospital Systems), Telemedicine Systems (Hospital)

Intervention Description: To examine the factors associated with delivery of preterm infants at neonatal intensive care unit (NICU) hospitals in Arkansas during the period 2001–2006, with a focus on the impact of a Medicaid supported intervention, Antenatal and Neonatal Guidelines, Education, and Learning System (ANGELS), that expanded the consulting capacity of the academic medical center's maternal fetal medicine practice.

Intervention Results: Perceived risk, age, education, and prenatal care characteristics of women affected the likelihood of use of the NICU. The perceived availability of local expertise was associated with a lower likelihood that preterm infants would deliver at the NICU. ANGELS did not increase the overall use of NICU, but it did shift some deliveries to the academic setting.

Conclusion: Perinatal regionalization is the consequence of a complex set of provider and patient decisions, and it is difficult to alter with a voluntary program.

Study Design: Time trend analysis

Setting: All Arkansas hospitals Five level III hospitals from 2001- 2005, six in 2006

Population of Focus: Infants born at <35 weeks GA

Data Source: Data from Medicaid claims for pregnancy linked to birth certificates for women covered by Medicaid in Arkansas

Sample Size: Total (n= 5,150) 2001 (n= 812) 2002 (n= 1,105) 2003 (n= 824) 2004 (n= 824) 2005 (n= 887) 2006 (n= 698) Infants born at <35 weeks GA

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Follow-Up Given On Transferred Patients, STATE, Perinatal Committees/Councils, NICU Bed Registry/Electronic Bulletin Board

Intervention Description: To determine whether perinatal care in southwestern Ontario is regionalized, to identify trends over time in referral patterns, to quantify trends in perinatal death rates and to identify trends in perinatal death rates that give evidence of regionalization.

Intervention Results: Between 1982 and 1985 the antenatal transfer rate increased from 2.2% to 2.8% (p less than 0.003). The proportion of births of infants weighing 500 to 1499 g increased from 49% to 69% at the level III hospital. The neonatal transfer rate increased from 26.2% to 47.9% (p less than 0.05) for infants in this birth-weight category and decreased from 10.2% to 7.1% (p less than 0.03) for infants weighing 1500 to 2499 g. The death rate among infants of low birth weight was lowest among those born at the level III centre and decreased at all centres between 1982 and 1985.

Conclusion: Perinatal care in southwestern Ontario is regionalized and not centralized; regionalization in southwestern Ontario increased between 1982 and 1985.

Study Design: QE: pretest-posttest

Setting: Southwestern Ontario One level III, one modified level III and 30 level II or I

Population of Focus: Births greater than 500 gm

Data Source: Data obtained from hospital delivery room books and for 31 of the 32 hospitals, from hospital charts of women and neonates.

Sample Size: Pretest: 1.17% (n= 194) Posttest: 1.31% (n= 211) Infants born weighing 500-1499 gm

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Consultation Systems (Inter-Hospital Systems), Educational Material (Provider),

Intervention Description: The DC Mental Health Access in Pediatrics (DC MAP) program is a child psychiatry access program (CPAP) that provides telephonic consultation services to primary care providers (PCPs) in Washington, DC. The program aims to increase access to mental health services for children and adolescents by providing PCPs with real-time access to child psychiatry experts who can offer guidance on diagnosis, treatment, and care coordination. The program also provides PCPs with information about community resources and referral options available to their patients. The program is staffed by a team of child psychiatrists, psychologists, and social workers who provide consultation services to PCPs on a range of mental health concerns, including depression, anxiety, ADHD, and behavioral problems,.

Intervention Results: DC MAP consult volume increased 349.3% over the first 5 years. Services requested included care coordination (85.8%), psychiatric consultation (21.4%), and psychology/social work consultation (9.9%). Of psychiatry-involved consultations, PCPs managed patient medication care with DC MAP support 50.5% of the time. Most (94.1%) PCPs said they would recommend colleagues use DC MAP, and 29.6% reported diverting patients from the emergency departments using DC MAP.

Conclusion: Yes, the study reported statistically significant findings, including a significant increase in consultation volume over the first 5 years of the program, as well as a significant difference between baseline and 1 year of participation in PCPs' ability to receive more timely care coordination services for their patients with mental health needs,,. Additionally, paired t-tests were conducted to analyze self-report data about PCP beliefs related to mental health services collected at baseline and again 1 year later, indicating statistically significant changes in PCP beliefs over time.

Study Design: The study design is a retrospective analysis of data collected from the DC Mental Health Access in Pediatrics program between May 2015 and May 2020. The study used a mixed-methods approach, including descriptive statistics and paired t-tests to analyze self-report data about PCP beliefs related to mental health services collected at baseline and again 1 year later.

Setting: The study was conducted in the primary care setting, specifically in pediatric primary care practices in Washington, D.C.. The DC Mental Health Access in Pediatrics program was designed to provide consultation services to primary care providers in order to enhance their ability to meet the mental health needs of their pediatric patients.

Population of Focus: The target audience for the study includes primary care providers (PCPs) who care for pediatric patients, as well as professionals involved in pediatric mental health care, such as child psychiatrists, psychologists, and other mental health specialists. The study aims to evaluate the effectiveness of the Child Psychiatry Access Program (CPAP) in supporting PCPs in addressing the mental health needs of children and adolescents in the primary care setting.

Sample Size: The study received 3,389 consultation requests from primary care providers (PCPs) between May 2015 and May 2020. This indicates a substantial sample size for evaluating the effectiveness of the Child Psychiatry Access Program (CPAP) in Washington, D.C.

Age Range: According to the PDF file, the DC Mental Health Access in Pediatrics program provides mental health consultation services for youth aged 0-21 years.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Access to Provider through Hotline, HOSPITAL, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Consultation Systems (Inter-Hospital Systems), Consultation Systems (Hospital), Telemedicine Systems (Inter-Hospital Systems), Telemedicine Systems (Hospital), STATE, Policy/Guideline (State)

Intervention Description: 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.

Intervention Results: Medicaid deliveries at the regional perinatal centers increased from 23.8% before the intervention to 33% in neonates between 500 and 999 grams (p<0.05) and was unchanged in neonates between 2001-2500 grams.

Conclusion: 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.

Study Design: Time trend analysis

Setting: All Arkansas hospitals

Population of Focus: Infants born weighing 500-2499 gm. Data not given for other study years.

Data Source: Data from Arkansas Vital Statistics Data System linked with corresponding hospitalization records from Arkansas Hospital Discharge Data System.

Sample Size: Total (n= 12,258) 2001 (n= 2,965) 2004 (n= 3,154)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Development/Improvement of Services, Continuing Education of Hospital Providers, Needs Assessment, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Agreement for Level III Hospital to Accept All Patients, STATE, Funding Support, Perinatal Committees/Councils

Intervention Description: A major objective was to develop and maintain a regionalized system of care. Such a system has been developed but differed from traditional systems by using regional level II centers. Iowa's low population density necessitated this modification.

Intervention Results: Level I hospitals currently manage low-risk patients and report very low mortality rates. Level II facilities receive high-risk referrals, but selective referral occurs since the tertiary center accounts for a disproportionate number of fetal and neonatal deaths, and births weighting less than 1500 g.

Conclusion: Other regions may benefit from similar approaches to development of regionalized systems of care and evaluation of the same.

Study Design: QE: pretest-posttest

Setting: All Iowa hospitals Pretest: 129 level I, 11 level II, and one level III hospital Posttest: 118 level I, 11 level II, and one level III hospital

Population of Focus: All infants born at ≥20 weeks GA and ≤1500 gm

Data Source: Data from Iowa State Health Department matched birth and infant death certificates.

Sample Size: Pretest (n= 432) Posttest (n= 343)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Development/Improvement of Services, Continuing Education of Hospital Providers, Needs Assessment, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Agreement for Level III Hospital to Accept All Patients, Perinatal Committees/Councils, STATE

Intervention Description: A voluntary system of regionalized perinatal health care was developed in Iowa to provide accessible services for a rural population.

Intervention Results: The intervention in Iowa focused on increasing both level III and level II VLBW births due to population density concerns in Iowa. Among all VLBW infants, there were changes in the birth location distribution. Of these infants, there was a statistically significant increase in percentage born in level III hospitals from 6.7% to 22.6% (p<0.05)1 and an increase in births in level II hospitals from 26.9% to 35.6%. The percentage born in level I centers decreased from 68.2% to 41.8%.

Conclusion: The concept of a mortality risk ratio (neonatal deaths/<1,500 gm live births) is suggested as a method of reviewing mortality data from the perspective of risks inherent in the population served.

Study Design: QE: pretest-posttest

Setting: All Iowa hospitals Pretest: 130 level I, 10 level II, and one level III hospital Posttest: 122 level I, 10 level II, and one level III hospital

Population of Focus: All live births <1500 gm

Data Source: Data from Iowa State Health Department matched birth and infant death certificates.

Sample Size: Pretest (n= 440) Posttest (n= 402)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Continuing Education of Hospital Providers, Peer-Review of Provider Decisions, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Consultation Systems (Inter-Hospital Systems), Consultation Systems (Hospital), Agreement for Level III Hospital to Accept All Patients, Medical Staff Integration

Intervention Description: Not available

Intervention Results: After the intervention, there was a statistically significant decrease in the number of VLBW infants born in a level II hospital (p<0.01).

Conclusion: Not available

Study Design: QE: pretest-posttest

Setting: Minnesota: Abbott-Northwestern/ Minneapolis Children’s Perinatal Center and Fairview-Southdale Hospital (Level II)

Population of Focus: All births at level II hospital

Data Source: Data source not provided.

Sample Size: Pretest (n= 2,573) Posttest (n= 2,722)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Transition Assistance, PATIENT/CONSUMER, HOSPITAL, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Neonatal Back-Transport Systems, Consultation Systems (Inter-Hospital Systems), Consultation Systems (Hospital), Telemedicine Systems (Inter-Hospital Systems), Telemedicine Systems (Hospital)

Intervention Description: Assessed a telemedicine (TM) network's effects on decreasing deliveries of very low birth weight (VLBW, <1500 g) neonates in hospitals without Neonatal Intensive Care Units (NICUs) and statewide infant mortality.

Intervention Results: Deliveries of VLBW neonates in targeted hospitals decreased from 13.1 to 7.0% (P=0.0099); deliveries of VLBW neonates in remaining hospitals were unchanged. Mortality decreased in targeted hospitals (13.0% before TM and 6.7% after TM). Statewide infant mortality decreased from 8.5 to 7.0 per 1000 deliveries (P=0.043).

Conclusion: TM decreased deliveries of VLBW neonates in hospitals without NICUs and was associated with decreased statewide infant mortality.

Study Design: QE: pretest-posttest

Setting: All Arkansas hospitals (Nine selected as telemedicine hospitals due to high patient volume)

Population of Focus: Infants born weighing <1500 gm

Data Source: Medicaid data for VLBW infants as indicated by ICD-9 diagnosis codes from hospital and physician claims for pregnancy. Data infant with birth and infant death certificates.

Sample Size: Pretest (n= 383) Posttest (n= 384)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination, Telemedicine Systems (Inter-Hospital Systems), Quality Improvement, Targeting Interventions to Focused Groups

Intervention Description: N/A

Intervention Results: Those with No USC and Facility USCs increased 10 and 18 percent, respectively, while those with Person USCs decreased by 43 percent. Compared to those in the lowest income bracket, those in the highest income bracket were less likely to have a Facility USC. Among those with low incomes, individuals with No USC, Person, in Facility, and Facility USCs were more likely to have ED visits than those with Person USCs.

Conclusion: A growing number are reporting facilities as their USCs or none at all. The impact of these trends is uncertain, although we found that some USC types are associated with ED visits and hospital admissions. Tracking USCs will be crucial to measuring progress toward enhanced care efficiency.

Study Design: We stratified each USC category, by age, region, gender, poverty, insurance, race/ethnicity, and education and used regression to determine the characteristics associated with USC types, ED visits, and hospital admissions.

Setting: 1996-2014 Medical Expenditure Panel Surveys

Population of Focus: Low income individuals, those with no USC

Sample Size: 559762

Age Range: All ages, five categories

Intervention Components (click on component to see a list of all articles that use that intervention): Maternal/In-Utero Transport Systems, INTER-HOSPITAL SYSTEMS, POPULATION-BASED SYSTEMS, Consultation Systems (Inter-Hospital Systems), Perinatal Committees/Councils, NICU Bed Registry/Electronic Bulletin Board

Intervention Description: The goal was to evaluate the impact of statewide coordinated changes in perinatal support and retrieval services on the outcomes of extremely premature births occurring outside perinatal centers in the state of New South Wales, Australia.

Intervention Results: There were 25% fewer nontertiary hospital live births (19.7% vs 14.9%) and more prenatal steroid use. Despite an 11.4% average annual increase in NICU admissions between the 2 epochs, fewer infants were outborn (12.0% vs 9.3%) and outborn mortality rates decreased significantly (39.4% vs 25.1%), particularly for those between 27 and 28 weeks of gestation. The overall improvement was equivalent to 1 extra survivor per 16 New South Wales births. There were also significantly fewer serious outcome morbidities in outborn infants during epoch 2, over the improvements in inborn infants.

Conclusion: Statewide coordinated strategies in reducing nontertiary hospital births and optimizing transport of outborn infants to perinatal centers have improved considerably the outcomes of extremely premature infants. These findings have vital implications for health outcomes and resource planning.

Study Design: QE: pretest-posttest

Setting: New South Wales, Australia hospitals Seven perinatal centers

Population of Focus: Infants born between 23+0 and 28+6 weeks GA who did not die before or during retrieval.

Data Source: Baseline population data for all births between 23 and 28 weeks GA obtained from the New South Wales Midwives Data Collection.

Sample Size: Pretest (n= 1,778) Posttest (n= 3,099)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Development/Improvement of Services, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Consultation Systems (Inter-Hospital Systems), Consultation Systems (Hospital), STATE, Policy/Guideline (State), Funding Support

Intervention Description: This report summarizes the evaluation of a national demonstration program of such regionalization that was funded by the Robert Wood Johnson Foundation (RWJF) in 1975.

Intervention Results: In both funded regions and comparison areas, the neonatal mortality rates decreased sharply over the decade of the 1970s. This decline was linked to shifts in the hospital of delivery that indicated antepartum risk identification and transfer of management of high-risk pregnancies to tertiary centers for delivery, a change in service pattern consistent with some aspects of regionalization. The centralization of high-risk deliveries appeared so widespread that the special effect of the RWJF program could not be detected.

Conclusion: Surveys of surviving 1-year-old infants showed that the decrease in neonatal mortality was accompanied by a decrease in selected morbidity.

Study Design: QE: pretest-posttest nonequivalent control group

Setting: Eight regions and eight comparison regions

Population of Focus: Infants born weighing ≤1500

Data Source: Data from reproduced computer tapes of births and matched infant death and birth certificates obtained from state and local health offices in several states.

Sample Size: Intervention group: Pretest (n≈ 4080) Intervention (n≈ 3416) Posttest: (n≈ 4033) Comparison: Pretest: (n≈ 5221) Intervention: (n≈ 4297) Posttest: (n≈ 4596)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Telemedicine Systems (Inter-Hospital Systems),

Intervention Description: N/A

Conclusion: 1. Telerehabilitation is a promising approach for children and youth with developmental disabilities, and can be more effective than face-to-face treatment or no treatment in improving outcomes. 2. Telerehabilitation interventions that target both the caregiver and the child, with clinicians actively involved and caregivers actively participating in treatment sessions, are more likely to be successful. 3. Family-centered care is beneficial for children and families when providing care, and addressing the needs of both the caregiver and the child is important. 4. Telerehabilitation interventions targeting improvement of parent-related outcomes are lacking. 5. Videoconference is the most commonly used platform for telerehabilitation interventions. 6. Certain professional disciplines, such as speech-language pathology, are more likely to publish studies on tele-assessment practices. 7. Blended models of care, where traditional face-to-face services are appropriately complemented by telehealth, could enhance healthcare delivery, access, and client-centeredness.

Study Design: Systematic Review

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Development/Improvement of Services, Continuing Education of Hospital Providers, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems

Intervention Description: Analysis of a maternal transport service within a perinatal region.

Intervention Results: Analysis of perinatal statistics from the Loyola University Perinatal Center from 1979 to 1986 supports: (1) increasing numbers of maternal and neonatal transports, with the number of maternal transports exceeding the number of neonatal transports since 1982; (2) increasing proportion of low birthweight and very low birthweight infants delivered at the perinatal center; (3) a decrease in the number of infants less than 1500 gm sent as neonatal transports; and (4) increasing proportion of neonatal transports with a birthweight greater than 2500 gm.

Conclusion: The perinatal mortality rate for the region has decreased from 1981 to 1986.

Study Design: Time trend analysis

Setting: Metropolitan Chicago: Cook County and Suburban Dupage County Two level I, 11 level II, and one level III hospitals

Population of Focus: Infants born weighing >500 gm. Data for entire region only given from 1981-1986.

Data Source: Data obtained from the Illinois Department of Public Health and Loyola University annual statistics reports.

Sample Size: 1981 (n= 18,365) 1982 (n= 19,460) 1983 (n= 19,162) 1984 (n= 19,379) 1985 (n= 20,132) 1986 (n= 19,751)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Continuing Education of Hospital Providers, Peer-Review of Provider Decisions, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Neonatal Back-Transport Systems, Medical Staff Integration

Intervention Description: To improve outcomes and maximize resource utilization, a regionalized system for high-risk perinatal and neonatal care is recommended.

Intervention Results: There was a significant decrease of 63% in the number of VLBW births at level II hospital after intervention (p-value and statistical test not indicated). The annual number of maternal transports to level III hospital increased 258% after intervention from an average of 38 per year to 98. The authors do not comment on statistical significance of this result.

Conclusion: With this process we were able to maintain a single level III subspecialty center, increase high-risk maternal transport, decrease neonatal transport, and limit VLBW deliveries outside of the level III subspecialty center.

Study Design: QE: pretest-posttest

Setting: Ohio, TriHealth Hospital System Two level II and one level III hospital

Population of Focus: Total sample size not given for pretest and posttest periods.

Data Source: Data from the National Institute of Child Health and Human Development Neonatal Research Network registry, the Regional Perinatal Database, and hospital records.

Sample Size: Total sample size not given for pretest and posttest periods.

Age Range: Not specified