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For mothers, better monitoring arrives digitally

Peggy Horn, a registered nurse and education coordinator at Avera Queen of Peace Hospital, checks patients' blood sugar levels daily as part of the hospital's gestational diabetes program. (Matt Gade / Republic)1 / 2
Peggy Horn, a registered nurse and education coordinator at Avera Queen of Peace Hospital, displays the AveraNow platform used to connect with patients on a more regular basis as part of the gestational diabetes program. (Matt Gade / Republic)2 / 2

With all of the technology available in the 21st century, there had to be a better way to treat gestational diabetes remotely.

And leaders at Avera Queen of Peace Hospital in Mitchell have found it.

Using glucometers that digitally transmit data to Avera Health and e-visits between nurses and patients, a three-year, $500,000 federal grant has allowed expecting mothers in rural areas to keep possible diabetic issues at bay by creating a new standard of practice through monitoring. The project is titled "Before Baby: Avera Remote Gestational Diabetes Monitoring" and was funded by the government specifically because it will serve rural, underserved areas.

"It's taken off and it's definitely become best practice," said Angie McCain, the project director of the grant and director of Women's Center at Avera Queen of Peace. "We're definitely excited about what we've seen so far."

So far, the research shows the effort has been successful. Since the program's start in August 2016, clinical data in the first two years shows a 10 percent decrease in cesarean section births. Gestational diabetes can lead to larger-sized newborns, and can cause long-term issues for both children and the mother.

In the program, when a problem with blood sugar is suspected, pregnant women are referred to the e-gestational diabetes teams, which involves weekly digital visits with a member of Avera's nursing or nutrition staff. Using testing supplies that connect to an app on the patient's smartphone, the blood sugar levels are transmitted to health care providers who can identify possible trends.

Peggy Horn, a registered nurse and education coordinator at Avera Queen of Peace, said that constant source of information can be monitored and allows them to intervene, if necessary, setting up a call or video chat that same day.

"If they're not feeling good, it's nice to know that as soon as possible, because we need to intervene," Horn said.

Previously, the common practice was for women to keep a log of their blood sugar levels and then go over them with their doctors monthly. But that period would often be too infrequent for pregnant mothers. The infrequent care could also lead to labor and delivery complications, and if uncontrolled, could lead to ongoing chronic diseases for the mother and baby.

Generally, an average-sized baby is in the vicinity of 6 to 8 pounds. Babies larger than 8 pounds, 13 ounces are considered are diagnosed with fetal macrosomia, which means larger than average.

So far, about 60 mothers have been monitored through the program. Horn said mothers in the program have been diligent about making sure they check in regularly to take care of the baby they are carrying.

In the program, mothers test themselves four times per day for blood sugar levels, once after fasting overnight and then within an hour of eating their three regular meals per day. Gestational diabetes is most commonly identified between the 20- and 24-week of the pregnancy. Given the average length of gestation is 40 weeks, that can mean there are 15 to 20 weeks of blood sugar monitoring every day.

"They show that maternal instinct, and they don't want anything that might harm their baby," Horn said. "The mothers in the program really do a great job of making sure they're doing what's best for them and their baby."

The goal will be for the program to continue after the grant ends Oct. 30, 2019. Avera Health expects to build out its service line to treat gestational diabetes using its digital platform, connecting expecting mothers with experts who can help across the Avera Health geographic footprint.

Mollie Loes, a registered dietitian in Mitchell working with the expecting mothers, said the program has driven home the importance of regular meals for the mothers, especially breakfast. "A regular breakfast is very important to keeping the blood sugar under control throughout the day," Loes said. "It's critical to getting the day started right."

Loes said she's found the entire project to be rewarding. If treated correctly, blood sugar following gestational diabetes generally returns to normal.

"It's awesome to see the smile on the mothers' faces when they've been able to make this connection and successfully complete the program," she said.

A big part of why the program has been successful is the functionality of it in rural South Dakota. McCain said some of their patients are as far away as 175 miles from a hospital with OB/GYN services. Avera said that in the second year of the project, the digital visits collectively saved more than an estimated 58,000 miles of driving.

Dr. Kimberlee McKay, an obstetrician/gynecologist and the Vice President of Avera's Obstetrics service line, noted 80 percent of South Dakota's mothers are working.

"Not every mother can take off a half-day of work," McCain said. "Instead, this might be a 10- or 15-minute call to make sure everything is OK, and they can get back to what they're doing and they don't have to make that drive."

The funding for the project came from the Health Resources and Services Administration's Federal Office of Rural Health Policy. Thirteen organizations around the country are working on various chronic health issues through the grant funding, but Avera's project is the only studying babies, McCain said.

In July, Avera Health received a "Patient Care Improvement Award" from the HRSA and its Small Health Care Provider Quality Improvement Program. Horn and McCain accepted the award in person, and McCain said there has been a lot of interest from their peers nationally about the progress of the grant and their study.

McKay says she hopes this sets the table for more advances in the near future, especially for chronic diseases. It could lead to virtual obstetrics visits, along with using telemedicine for diagnosing preeclampsia (high blood pressure during pregnancy) and pre-term visits.

She said the battle is to get insurance companies to cover new technologies in patient care and also to secure funding to make those advances happen.

"Innovation in health care is difficult and it's expensive," McKay said, who laughingly added they're looking for an $8 million donation for their future projects. "We've got more projects we want to take on over the next 3 to 5 years. And we're looking forward to the future of that."

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