Key points from today’s guests:

Morning Rounds – Summary of Recent News

Jodi Schmidt, executive director, Care Collaborative

• The Care Collaborative started 10 years ago as a small network of rural hospitals and providers who came together to improve treatments and outcomes.
• It now has 85 members across 73 Kansas counties.
• Our data has shown that we've improved care more than 90 percent of the time.
• We help bring services to the rural community because we know they have such limited resources.
• The stroke team here has a bat phone -- yes, it's called a bat phone – so that they can reach out and get guidance and support around an individual patient situation.
• We also have identified gaps in areas like telehealth and home-based care.
• We really work to not just bring the education, but to provide wraparound support through the Care Collaborative.

Focus Topic

Dr. Steve Stites, chief medical officer, The University of Kansas Health System

• Too many women -- and women of color especially -- are dying during pregnancy.
• Today we're focused on one reason for these preventable deaths –"maternity deserts.”
• These are areas where there is little to no pregnancy care and it is particularly prevalent in Nebraska, Kansas, Oklahoma, and Texas.
• Nearly two million women of reproductive age live in “maternity deserts.”
• How can a community really grow and thrive if they don’t have the resources to support delivering babies?

Jennifer Cunningham, Garden City, Kansas, mom

• When she was 35 weeks pregnant with her oldest eight years ago, she started having some really bad pain in her left leg to the point where her leg was dragging.
• Although the local hospital didn’t think it was serious, she went anyway to have it checked out and it turned out to be an 18-inch deep vein thrombosis from her hip to her knee.
• Her husband reached out to The University of Kansas Health System and they instructed them to head there right away – but it was 6.5 hours away from their home in Garden City, Kansas.
• Jennifer wound up staying in a hotel near the health system for the next three weeks until giving birth, which was very stressful and very expensive.
• There are few local maternal fetal care resources for moms in her hometown, and new ones are not coming.
• She said that if towns can’t provide basic services, those towns can’t survive.

Dr. Bob Moser, executive director, Kansas Center for Rural Health

• We are looking at regional collaborative approaches to providing rural health care.
• We can use remote patient monitoring and care coordination like we've done with our chronic care managers to help support in between the clinic visits to patients back in their home communities to just make sure that everything's going according to plan -- whether it's blood pressure monitoring, blood sugar monitoring, weight gain, etc. -- and that the provider is getting that information in real time and able to act on it when there's a red flag
• There is a lot of great work going on across Kansas with a public health approach like the Kansas Perinatal Quality Collaborative, along with the Kansas Maternal Mortality Council.
• I think our health systems have to get engaged in the public health side of this. And the public health side has to recognize the challenges and find the time to engage in some of the work at the local level.
• Better collaboration and better communication has an opportunity for some rapid improvement.
  
  

Dr. Carrie Wieneke, clinical service chief, obstetrics and gynecology, The University of Kansas Health System

• Among the top 10 national patient safety concerns for the upcoming year is access to maternal and obstetrical care.
• When it comes to the maternal mortality and infant mortality rates in the United States, a lot of factors that are contributing, but we do know that the longer a patient drives, they have a higher risk of higher morbidity for the mom and the baby.
• For some patients, the long drive might make them stay home longer versus driving to those specialized services.
• In 2013, when he looked at the first data, there were no certified nurse midwives in rural Kansas. We do have certified nurse midwives in Kansas, but more in the urban areas.
• Certified nurse midwives are nurses and they have extra doctorate level training and are trained to deliver neonatal care, delivery care and postpartum care as well as reproductive health care.

Dr. Marc Parrish, maternal-fetal medicine specialist, The University of Kansas Health System

• We still need to get providers out in rural Kansas that can provide this type of maternal care to improve access for patients.
• Telehealth can help to identify patients that are higher risk.
• So for those in between visits, telehealth can reduce having to travel so far each time to other urban areas.
• By being able to identify those patients that are higher risk, we can set up a plan and be prepared for those emergency type situations so that patients know exactly what they need to do if there are specific symptoms they start to experience.

Dr. Sandra Stites, OBGYN, chief medical officer, Vibrant Health

• Vibrant Health is a federally qualified health center and we provide culturally sensitive care and we provide it in their own language.
• So we hire from within our community, but also promote within our community.
• We really work hard to establish that we are community partners and hope that the community feels that with us as well.
• So when our patients come, they are coming to a space that they hopefully feel very comfortable. And we have we feel as though we are trusted and we hope that our patients build that trust.
• We do hear our patients and they feel heard.

Dr. Michael Kennedy, family medicine physician, The University of Kansas Health System

• We looked at maternity care available resources across Kansas by county from 2013 to 2023.
• We saw that services were going in the wrong direction – there were decreased or eliminated OB services in many Kansas counties.
• From a rural perspective, it's challenging if you're the only provider providing obstetrical services because you're basically on call 24/7.
• Then you need the support staff -- nursing staff trained and comfortable in providing labor and delivery services and postpartum care.
• Many rural hospitals are served by a certified nurse anesthetist. And if you don't have one there then that means when an OB patient comes in, you have to call to find out if they're available, but that's an added cost to the local healthcare system.
• Trainees don’t want to go to that kind of environment either.

COVID Update

Dr. Dana Hawkinson, medical director of Infection Prevention and Control, The University of Kansas Health System

• The hospital COVID count for this week is up to 12 inpatients, which is an increase from eight last week.
• A recent study found that COVID vaccine confidence dropped among pregnant women.
• We need to continue increase access to care and health education, explaining and showing the safety and the efficacy of not only vaccines but other aspects of care as well.

Thursday, April 11 at 8 a.m. is the next All Things Heart. Hear about one patient who went to bed with leg pain and woke up to a leg that had doubled in size. See the life-saving treatment that had him back on his feet.

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