Subject(s)
COVID-19 , Fetal Diseases , Neonatology/trends , Perinatal Care , Pregnancy Complications , Telemedicine , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Disease Transmission, Infectious/prevention & control , Female , Fetal Diseases/diagnosis , Fetal Diseases/epidemiology , Health Services Accessibility , Humans , Infection Control/methods , Perinatal Care/organization & administration , Perinatal Care/trends , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/epidemiology , Pregnancy Complications/prevention & control , Professional-Family Relations , Program Evaluation , Remote Consultation/organization & administration , Remote Consultation/statistics & numerical data , SARS-CoV-2 , Telemedicine/methods , Telemedicine/organization & administration , United States/epidemiologyABSTRACT
The COVID-19 pandemic has caused an explosive adoption of telehealth in pediatrics . However, there remains substantial variation in evaluation methods and measures of these programs despite introduction of measurement frameworks in the last five years. In addition, for neonatal health care, assessing a telehealth program must measure its benefits and costs for four stakeholder groups - patients, providers, healthcare system, and payers. Because of differences in their role within the health system, each group's calculation of telehealth's value may align or not with one another, depending on how it is being used. Therefore, a common mental model for determining value is critical in order to use telehealth in ways that produce win-win situations for most if not all four stakeholder groups. In this chapter, we present important principles and concepts from previously published frameworks to propose an approach to telehealth evaluation that can be used for perinatal health. Such a framework will then drive future development and implementation of telehealth programs to provide value for all relevant stakeholders in a perinatal health care system.
Subject(s)
COVID-19 , Child Health Services , Neonatology/trends , Perinatal Care , Remote Consultation , Telemedicine , COVID-19/epidemiology , COVID-19/prevention & control , Child Health Services/organization & administration , Child Health Services/trends , Female , Health Services Accessibility , Humans , Infant Health/trends , Infant, Newborn , Infection Control/methods , Perinatal Care/organization & administration , Perinatal Care/trends , Pregnancy , Program Evaluation , Remote Consultation/organization & administration , Remote Consultation/statistics & numerical data , SARS-CoV-2 , Telemedicine/methods , Telemedicine/organization & administration , United States/epidemiologyABSTRACT
The reduction in the use of neonatal intensive care units (NICUs) during the COVID-19 outbreak has been reported, but whether this phenomenon is widespread across countries is unclear. Using a large-scale inpatient database in Japan, we analysed the intensive neonatal care volume and the number of preterm births for weeks 10-17 vs weeks 2-9 (during and before the outbreak) of 2020 with adjustment for the trends during the same period of 2019. We found statistically significant reductions in the numbers of NICU admissions (adjusted incidence rate ratio (aIRR), 0.76; 95% CI, 0.65 to 0.89) and neonatal resuscitations (aIRR, 0.37; 95% CI, 0.25 to 0.55) during the COVID-19 outbreak. Along with the decrease in the intensive neonatal care volume, preterm births before 34 gestational weeks (aIRR, 0.71) and between 34 0/7 and 36 6/7 gestational weeks (aIRR, 0.85) also showed a significant reduction. Further studies about the mechanism of this phenomenon are warranted.