Missouri's rate of deaths due to pregnancy and childbirth is one of the highest in the country.
Missouri’s rate
is 28.5 deaths per 100,000 live births which is on par with Belize according to the
CIA’s World Factbook
. But two ECHOs in Missouri are working to close the gap: the High Risk OB Partnership for Excellence (HOPE ECHO) and Challenges in Rural Obstetrics for Women and Neonates (CROWN ECHO).
The
Project ECHO
telementoring model began in New Mexico and has since spread across the country, connecting primary care providers with teams of specialists to learn from one another and improve care for patients. Show-Me ECHO, Missouri’s ECHO program, has been a leader in delivering ECHOs in the Midwest. The HOPE and CROWN ECHOs connect primary care providers to specialists such as OB/GYNs and neonatologists to share information to help pregnant patients.
CROWN ECHO is designed to help pregnant women living in rural areas get the care that they need and combat the shortage of pregnancy specialists in rural areas. Sixty-seven of Missouri's counties don’t have a single OB/GYN and connecting primary care physicians and nurses working in rural areas with pregnancy specialists can increase specialized knowledge in areas that don’t have the resources to hire an OB/GYN.
“Distance is a challenge in practicing medicine in a rural state,” said Daniel Jackson MD, a doctor of maternal and fetal medicine who is on the CROWN ECHO leadership team. “We have to find a way to use technology to bridge that gap and come as close as we can in trying to disseminate sub-specialist knowledge for these increasingly complex patients we’re seeing.”
HOPE ECHO is for women in urban areas who are at a high risk for serious pregnancy complications. Despite geographic closeness to hospitals, women in urban areas still struggle to see specialists because of limited resources.
“The issue is the patients and the women don’t know how to access resources," said Sarah Dickerhoff
MSN, RNCC-MNN
, a labor and delivery nurse on the HOPE ECHO leadership team. "Maybe they have different struggles with transportation or they work or they don’t have child care or they don’t have insurance... A big focus for the urban ECHO is looking at race and the inequality of access to health care based on social determinants [of health]."
Topics have included substance use, preeclampsia and gestational diabetes.ECHOs are designed to be accessible for more than just doctors. Nurses, physicians assistants, pharmacists and social workers have also participated in the ECHOs to learn more about what they can do to protect women's health. ECHOs are designed to be casual and conversational with case studies from attending doctors and discussions with the group.
“It’s a very informal session, said Jackson. “It’s not a stuffy, white-coat kind of thing. It’s kind of what you would expect if you got a bunch of physicians who take care of pregnant women and doctors and nurses and social workers and all got around the table for dinner.”
