How to Use New Technology to Make a Meaningful Connection

With the nation's maternal mortality rate rising, hospitals are turning to text messages to make a connection with at-risk mothers.

With recent news that the maternal death rate rose significantly in 2021, healthcare leaders are looking for innovative and effective ways to connect with at-risk mothers-to-be and collaborate on better care management and outcomes.

In Dallas, the spotlight is on the Preterm Birth Prevention Program launched in 2018 by Parkland Hospital and the Parkland Center for Clinical Innovation (PCCI). The program, which affects some 13,000 mothers-to-be a year, uses data on social drivers of health (SDOH) to identify at-risk women and develop targeted interventions aimed at improving care.

"Healthcare itself only accounts for 15% to 20% of health outcomes," says Yolande Pengetnze, MD, a pediatrics specialist and PCCI's vice president of clinical leadership. "True health … comes outside of the health system. That's where we need to be."

The program is one of many being deployed by health systems and payers across the country to tackle the high maternal mortality rate, especially among underserved populations. Many of these efforts are looking outside the typical boundaries of clinical treatment to community and cultural factors that affect healthcare, including employment, housing, transportation, education, daycare, welfare, cultural biases, and other factors that affect healthcare access.

Parkland's program tracks socioeconomic and demographic factors and clinical data to identify pregnant women at risk of preterm delivery. The data also helps providers at Parkland design personalized care plans that meet both the care team's needs and the patient's preferences.

"An informed patient is the best patient in healthcare," says Pengetnze, who notes that prior to using this technology, "we'd wait for them to come to the doctor."

Yolande Pengetnze, MD, vice president of clinical leadership, Parkland Center for Clinical Innovation. Photo courtesy PCCI.

The program is run through a health plan, which uses its database to screen for social drivers of health (SDOH) and make that first connection to patients through their care managers and text messaging. From that point, the patient is directed to a wide range of care management resources, and are even connected to a social worker if needed. In addition, a care team at Parkland is brought in to manage clinical interventions.

"We're trying to create some sort of continuum of care for these patients and be proactive," Pengetnze says. "We want to be able to identify these problems before they come to the doctor."

The program uses personalized text messages like the following:

• Remember to take your prenatal vitamins every day! Prenatal vitamins help you and baby get all of the vitamins and minerals you need for healthy growth.  
• Doctor's visits are a great time to ask all your questions about pregnancy! Bring a list of anything you want to know. 
• In the third month, baby will be the size of a peach! 
• Ask your doctor about the signs of labor at your next doctor's visit. It is helpful to know the signs of labor to know when to start preparing. 
• Stay Safe! Make sure to wear your seatbelt under your belly and over your hips, NOT over your belly. Also try not to drive more than 5 to 6 hours a day. 

Pengetnze says the messages are sent two to three times a week, sometimes more often for women deemed at high risk.

And this method has worked. According to officials at Parkland, the interventions have helped to reduce the preterm delivery rate by 20%, boosted prenatal visits to the doctor by some 8%, and reduced costs by 6%. A survey of those taking part in the program, meanwhile, found that almost three-quarters said they felt better prepared to take care of themselves and their new family members.

Those percentages are particularly important to the Medicaid population, which sees a higher rate of preterm deliveries and complications due to access issues. Surveys have shown that socioeconomic factors contribute to stress and depression, which in turn affect preterm health.

The challenge lies in reaching those underserved populations and identifying who needs help. Pengetnze says HIPAA (Health Insurance Portability and Accountability Act) guidelines can hinder how providers use data and connect with patients, while providers often can't locate or access the socioeconomic data they need because patients are reluctant to provide that information. And since text messages aren't secure communications, the program needs consent from the patient before sending them.

"Some women don't even want it known that they are pregnant," she points out. "With SDOH, some data elements are sorely missing in the system. The EHR is a good platform, but we need technology that can collect that type of data and standardize it."

Noting the success with at-risk pregnant women, Pengetnze says the platform can be used to target other populations and health concerns.

"The [text messaging] platform is good because it's simple, and that's what we need to reach out to these populations," she says. "We need to make it simple for them [to connect], and then we'll do the complex part. Any additional step in that process increases the risk of losing that patient along the way."