1. Describe your topic

The COVID-19 pandemic further exacerbated the already worsening maternal mortality and morbidity crisis in the United States by overwhelming our healthcare system and disrupting basic access to quality prenatal and postpartum health care for many communities. With the proliferation of digital health technologies and interventions over the last decade, how can tools such as telehealth and remote monitoring improve maternal health care and support better outcomes? What are the opportunities to enable these tools and what are the obstacles preventing greater utilization? What is the evidence base for increased digital health for maternal health care that reduces costs; improves maternal population health, patient experience, and productivity in obstetrics?

Identify the population of interest, including details such as age range, gender, coexisting diagnoses, and reasons for therapy.

Women in prenatal and postnatal stages who lack access to maternal care, particularly in rural and underserved communities that do not have reliable access to adequate maternal and infant care, would benefit from enhanced access to maternal health consultations, treatments, and other services via remote modalities that can improve outcomes while reducing costs for all involved.

Identify the interventions (treatments, tests, or strategies) that you want to know more about, and what are the appropriate comparisons.

How can digital health interventions augment or replace in-person maternal care, particularly when access to in-person care is unreliable (or limited due to socio-economic or racial bias)? Proposed interventions can include a range of services such as mental health evaluations and treatments, chronic and acute condition management, care planning, and other strategies that are timely and appropriate based on live audio and audio-video telehealth, and patient-generated health data collected via noninvasive remote monitoring devices that capture, wirelessly record, and transmit maternal health biomarkers (such as heart rate, temperature, activity, etc.).  Additionally, strategies that will strengthen and support women's health by increasing and improving reimbursement for care integrated telehealth models for maternity care services should be investigated.

Identify the important outcomes (health related benefits and harms) in which you are interested, such as improvements in symptoms or problems with diagnosis.

Aggregation of the state of the evidence regarding the use of digital health tools in maternal care to date, including statistics on reduced complications in childbirth, maternal mortality and maternal health in both the pre- and post-pregnancy phases, and cost savings; identification of areas in need of further study; and identification of any roadblocks (infrastructure, workforce culture, legal, etc.) that should be addressed by policymakers in order to better utilize digital health tools in maternal health scenarios.

2. Describe why this topic is important

The United States leads the developed world in maternal mortality rates. According to the CDC, around 60% of pregnancy-related deaths in America are preventable, and cases of severe maternal morbidity can lead to significant short- or long-term consequences to a woman’s health. Further, Black women and American Indian and Alaska Native women are at an increased risk of dying from pregnancy-related complications or losing an infant to premature death. Additionally, the pandemic also affected maternal health care, cancellation of prenatal visits, hospitals enacting restrictions on who could be with a mother during delivery and even the shuttering of some birth-related services, at least temporarily. The number of home births rose by nearly 20% in 2020, from more than 38,000 in 2019 to more than 45,000.  According to the Commonwealth Fund, elevated levels of issues like depression and anxiety among many pregnant women during the pandemic also worsened maternal mortality in the US.

The Biden-Harris Administration has issued a Call to Action to reduce maternal mortality and morbidity based on the fact that women in underserved communities do not have access to adequate maternal care and has emphasized that this lack of access contributes to the widening of inequities in healthcare more generally. This, combined with a caregiver workforce shortage, means that better leveraging digital/remote modalities is critical to meeting the maternal care needs of women, particularly those in underserved areas and communities. Digital remote maternal care tools, such as asynchronous remote monitoring and telehealth, allows patients to receive the ongoing care needed to improve their outcomes whenever and wherever it is needed. Through recurring monitoring while the patient is outside of the hospital setting, timely and appropriate updates to care plans and/or interventions can be made when remotely monitored parameters are exceeded, and can lead to improved patient engagement in their own care. Yet, as the Administration has noted, such capabilities and their benefits are far from realized.

3. Tell us why you are suggesting this topic

We believe that digital health tools can play a key role in addressing the maternal mortality crisis in this country. They can fill in gaps between in-person visits by activating and engaging patients, and can provide patients and their health care providers with health data, information, and knowledge to track and monitor existing conditions or patients who may be at an increased risk. There is also a tremendous health equity component that needs to be examined, particularly given that there are considerable racial and ethnic disparities in pregnancy-related mortality and morbidity. Digital health tools may help address certain factors contributing to these disparities.

Greater use of digital health tools in the maternal health context is driven in many ways by the efforts of the Centers for Medicare and Medicaid Services (CMS) and its various related programs and priorities. Past CMS’ existing remit, Congressional action is likely needed to enable the agency to fully leverage the broadest set of digital health tools in addressing maternal health. Both CMS and Congress scrutinize the costs associated with enabling greater access to Medicare programs in light of the associated costs (and misinformed assessments very typically result in proposals failing), so their understanding of the improved outcomes and cost savings associated with using digital health tools to improve maternal health is essential, particularly in the context of the Administration’s imperative for addressing disparities in healthcare as well as its Call to Action for improving maternal health. An evidence review supported by AHRQ would provide them with authoritative resource to base their decisions on. Such evidence will also support progress towards a true value-based care healthcare system for the United States.

Secondarily, private payers and providers will similarly benefit from such an evidence review as they seek to realize their own similar value-based care goals.

Tell us if you have a target date for answering your question and whether you are under a specific timeline.

Target date (month/day/year):

We urge AHRQ to complete this Evidence Review as soon as practicable, but no later than December 1, 2022. Given the imperative for improving maternal health, particularly for underserved communities across the country, such a report is needed and timely.

4. Describe what you are doing currently and what you are hoping will change because of a new evidence report.

As envisioned, this evidence review will improve practice widely via informing policymakers (both in government or outside of government) about the state of the evidence with respect to the efficacy and quality of maternal health telehealth and remote monitoring technologies and solutions and how such technologies fit into the Quadruple Aim, supporting their adoption and support. Building on the analysis and conclusions of this envisioned evidence review, providers, payers, and technology developers can explore new ways to improve maternal health using remote digital health tools and services.

5. How will you or your group use the information from a new evidence report?

CHI would use this report to work with various stakeholders to support policymaker decision-making processes related to policies that impact maternal health. And more broadly, this would inform the use of connected health innovations across public and private systems, both in the U.S. and elsewhere. Members, supporters, and partners of CHI will also find the data from the evidence report useful. This evidence report’s impact, coming from AHRQ, would be extremely impactful.

6. How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?

We would share public links to the report and cite it in our own written and spoken advocacy across any appropriate fora, and work jointly with the selected EPC to promote the report’s findings in other ways. This report could also be used to inform further research opportunities to inform best practices and update standards of care for maternal health.

7. Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?

CHI believes that the envisioned evidence review would assist government and non-government national and state-level organizations that influence clinical practices and standards (of which several are members, supporters, and partners) to make better-informed decisions about digital tools used for maternal health. CHI would also share the findings with federal policymakers to support their informed decision-making processes that impact maternal health, also impacting clinical practices and population health outcomes.

Information About You

Provide a description of your role or perspective (e.g., patient/consumer, physician, professional society, administrator):

The Connected Health Initiative (CHI) is the leading multitask holder effort aiming to accomplish policy changes that will drive the responsible use of digital health tools across the healthcare ecosystem. CHI is driven by a community consensus that includes providers, payers, technology developers, patients, and others. Go to www.connectedhi.com.

Please tell us how you heard about the Effective Health Care Program

AHRQ email announcements/AHRQ website.

(Optional) Your name and contact information

Your personal information will not be displayed on the EHC Program Web site, nor will it influence your suggestion for a new evidence report by the EHC Program. It will only be used to contact you for additional information about your suggestion, if necessary. It is not mandatory that you provide your contact information, but it is often helpful for us to contact the person who submitted the suggestion, when we need help clarifying a research question.

If you are you making a suggestion on behalf of an organization, please state the name of the organization: Connected Health Initiative, 1401 K St NW (Ste 501), Washington, DC 20005, www.connectedhi.com

Would you be willing to partner with another organization to develop policy, program, guidelines, or dissemination and implementation materials? (yes/no)

May we contact you if we have questions about your nomination? (yes/no)