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M-STORC On Track to Deliver Improved Equity for Maternal Health

By Denise Schiavone

In assessing the impact of telemedicine, having good data is crucial. But for prenatal care, research gaps prompt the big question: Does obstetric (OB) telehealth miss the mark when it comes to equity? The MITRE Simulation for Telemedicine for OB Research Communities tool aims to get answers.

For people from underserved communities, the period from COVID to present day exacerbated many major health concerns and disparities. For example, the pandemic worsened the ongoing U.S. maternal mortality crisis, which disproportionately impacts Black and American Indian/Alaska Native (AI/AN) women. 

One positive outcome that COVID inspired: improved virtual-care options to meet patients where they are. Yet even as telemedicine becomes mainstream, it’s not a one-size-fits-all solution. Questions persist around which options work and for whom. 

The simple answer is we don’t know. Research doesn’t consistently collect and map patient demographics to research results. And despite known maternal health inequities, studies of OB telehealth tend to look at white, college-educated, privately insured participants.

“To prevent the perpetuation of existing disparities, we need to apply an equity lens to OB telehealth research going forward,” says MITRE health system analyst Sabrina Movitz.

Movitz and fellow researchers from our independent R&D program collaborated with Mayo Clinic to do just that. The MITRE Simulation for Telemedicine for OB Research Communities (M-STORC) decision-support tool offers a valuable resource for modeling OB telemedicine outcomes, driving more-equitable prenatal care.

Our experts applied methods and findings from Mayo Clinic’s OB Nest research program, which offers a variety of asynchronous components for health providers to engage patients throughout the prenatal journey. These include texts, calls, and at-home vitals screening options that can save patients money, time, and stress. M-STORC incorporates various non-medical factors that impact health outcomes, like economic stability, housing status, education level, language literacy, and internet access. 

These social determinants of health raise key questions about the appropriate use of OB telemedicine for patients from underserved populations. For Black and AI/AN women—two to three times more likely to die from childbirth than white women—the answers can be literally life-saving. 

If we want telemedicine to be a solution for those in historically marginalized communities, we need to bring those people into the center of the conversation.

Sabrina Movitz

Act/Pause/Reflect Model Informs Patient Care

The M-STORC research effort included MITRE experts in maternal health, modeling and simulation, data analysis, social behavior, and user interface. Over the course of a year, the multidisciplinary team collaborated extensively with Mayo Clinic staff on the development of the prototype’s interactive features.

M-STORC expands on the success of Mayo Clinic’s virtual OB care program, now used for all their low-risk OB patients. The tool aims to address the needs of underserved and high-risk patients by incorporating synthetic-population data from different insurance types, rural versus urban areas, and maternity-care deserts. This allows OB researchers, providers, and clinical administrators to visualize access to care based on location and determine if telemedicine is a good choice for their patients. 

For example, what would it look like over time if a specific patient population uses this telemedicine program? Would it help them keep their appointments? Would it increase their satisfaction with their care? How do providers and patients of different ethnic backgrounds feel about a digital medical delivery system? 

“If we want telemedicine to be a solution for those in historically marginalized communities, we need to bring those people into the center of the conversation and into the research design,” Movitz explains.

Beyond research applications, M-STORC can also leverage real-world data to help assess telehealth’s suitability for actual patients. It allows practitioners to evaluate holistic factors such as how far a patient lives from the hospital, whether they have childcare, and if they potentially suffer from intimate-partner violence (making in-person visits safer). Using a color-coded dashboard, practitioners can then make an informed decision to Act, Pause, or Reflect on whether telemedicine or in-person care will drive the best outcomes. 

M-STORC Labors On Toward Equitable Solutions

M-STORC a color-coded dashboard shows demographics and medical data to determine telemedicine suitability

M-STORC's user-friendly dashboard helps practitioners assess telehealth's suitability for various patients.

The M-STORC team says the “dream state” would be for the tool to eventually live within electronic health records for regular use in prenatal care services. For now, the MITRE-Mayo Clinic collaboration is focused on socializing their work in the maternal-health community.

They shared research findings in the Georgetown Medical Review and Telehealth and Medicine Today and at the 2023 American Public Health Association Conference—sparking dialogue critical to making progress. 

“Equity is one of those buzzwords you hear a lot, but we’re trying to take the conversation further,” says MITRE’s Alison Dingwall, Ph.D., project co-principal investigator. “We don’t have all the answers; but by highlighting the existing gaps, we’re challenging researchers, policymakers, providers, and the public to think more innovatively and forge real change for prenatal care.”

The initiative expands on our previous work developing data-driven solutions for maternal health, such as the Maternal Mortality and Morbidity Interactive Dashboard (3MID). Like 3MID, M-STORC’s technology can be transitioned for broad potential OB applications. It’s also shaping new efforts, such as Movitz’s project under MITRE’s Early Career Research Program to explore using doulas for underserved patient populations.

“This is just the beginning,” she says. “I’m excited about our ability inform future research to improve obstetric-health equity.”

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