Distances as far as 283 miles from home to specialists and better-equipped hospitals. Rising obesity, gestational diabetes and hypertension. Fewer Kansas hospitals delivering babies. For moms, babies and rural Kansas, they add up to a health problem, as prenatal and obstetrical care are often far away and early diagnosis of high-risk pregnancies is challenging.

“All across the country, rural hospitals are closing their doors or closing their obstetric units,” says Lisette Jacobson, Ph.D., MPA, associate professor, Department of Population Health and Department of Obstetrics & Gynecology at KU School of Medicine-Wichita, whose work focuses on maternal health. “But women still have pregnancies, and women still have high-risk pregnancies and live in rural areas. Just because you live in a rural area doesn’t mean you shouldn’t have access to high-quality obstetric care.”

Jacobson is part of a multi-campus KU-led team applying experience and expertise to the challenge using a four-year, $3.8 million federal grant. As with many things rural and medical, Sunflower-MOMS involves a collaborative approach. It’s part of a federal program, RMOMS (Rural Maternity and Obstetrics Management Strategies), to improve access to obstetrical care and, as a result, reduce maternal mortality. Statistics vary, but U.S. maternal death rates are persistently higher than in other developed countries.

The Kansas team includes School of Medicine and School of Nursing faculty and staff from Wichita, Salina and Kansas City and is led by Karen Weis, Ph.D., RNC-OB, FAAN, Christine A. Hartley Rural Health Nursing professor at the School of Nursing-Salina and research director at the Kansas Center for Rural Health. Jacobson will handle the evaluation piece, assessing the effectiveness of training and ensuring with the help of a data manager that the federal government gets the information it requires.

The program they’re developing includes:

• Specialized training for sonographers.
• Consultations and case reviews by maternal-fetal specialists.
• Expanded training for family medicine doctors, nurses, EMTs and paramedics handling deliveries.
• Obstetrics care navigators for mothers-to-be.
• Development of a system of sharing medicine, equipment and blood between facilities (an issue of cost and expiration dates for those with fewer deliveries).

“Every single element within our project is to get the mother to the right place at the right time,” said Weis, who is also interim dean at the School of Nursing-Salina. “We have to make sure that the closest place that mother can go is prepared to take care of her in the best way they can, and when they can't, then we need to make sure there's a process to get them to that next highest level of care in the most expeditious way.”

A network within a network

Salina-based Sunflower Health Network is a key piece of the program, as it fulfills the federal requirement of using existing networks instead of building from scratch. The network’s mission is to help its 27 members — in 26 mostly north central and northwest Kansas counties — make the most of their resources by coordinating training, purchasing, quality initiatives and other services. Twenty-five members are critical access hospitals, meaning no more than 25 beds and typically over 35 miles from the next nearest hospital.

Five members are taking part: Mitchell County Hospital in Beloit, Smith County Memorial Hospital and Rural Family Practice in Smith Center, Gove County Medical Center in Quinter, Citizens Medical Center in Colby and AmberMed in Hoxie, which provides prenatal care but not deliveries.

“With a lot of rural hospitals not doing OB anymore, that puts more of a burden on those that do. They’re seeing increased numbers, and mothers and families have farther to travel to get care, and for specialized care they're traveling several hours,” says Heather Fuller, Sunflower Health Network executive director. “And the hospitals that don't do OB anymore still have to have staff trained in case somebody drops in and has an emergency delivery. It’s a huge issue for members.”

Other Sunflower Network hospitals, directly or indirectly, will benefit from training and a system to improve care.

“It's exciting to know that these processes will be put in place for years to come. We're going to have the systems there to continue this training. A lot of pieces will hopefully be embedded throughout the region,” Fuller says.

Pieces of the plan

This year is a planning year for the grant team, as they put people, plans and equipment in place. Technology and training are central to the effort, with sonography a major emphasis.

Just like doctors and nurses handle a wide variety of medical issues in rural areas, sonographers are generalists, too. The program will provide them with specialized obstetrical training, so they can perform better scans and help uncover fetal heart, kidney and other abnormalities that can endanger babies and mothers. Another common issue is gestational diabetes, which can result in low birth weights and preterm births.

Maternal-fetal specialists Brian Brost, M.D., and Marc Parrish, D.O., professors of obstetrics and gynecology at KU School of Medicine in Kansas City, will coordinate the training, consult on sonograms and cases, and perform case reviews to help rural providers boost knowledge and skills.

“By training the local workforce and providing teleradiology and specialized training to sonographers, they can determine very early on during pregnancy whether a mom needs a higher level of care,” Jacobson says.

Dinesh Pal Mudaranthakam, Ph.D., MBA, assistant professor of biostatistics and data science and director of research information technology at KU School of Medicine in Kansas City, and co-workers are helping with technology on several fronts. They will build a platform so hospitals can communicate across different electronic medical record systems, ensure high-quality images flow to specialists, and help Jacobson obtain government-required data. They’ll also put artificial intelligence to work screening sonograms, so providers can be flagged about possible issues.

“They're never going to eliminate the radiologist, but what our team is trying to do is use algorithms to segment the sonogram images and identify the abnormality within those images,” Mudaranthakam says.

Both Weis and Jacobson note that, by design, the program is intended to build a system that outlasts the grant’s four years and can spread across the full Sunflower Health Network.

“We can prevent so many of the problems,” Weis says. “It’s not that people are getting bad care. It’s that their care was limited by the available resources. Kansas should be very proud of what they do. We have funding that can actually make things better.”

Fuller says her members appreciate resources coming to them instead of the other way around.

“They're always excited for more training, and especially training that's close to them instead of having to travel across the state and be out of the hospital for several days, especially when they might be the only person at their hospital that does that type of thing,” Fuller says. “And having experts right at their fingertips to help as needed, that's going to be a huge benefit to patients and their families.”

Above, from top to bottom: Lisette Jacobson, Ph.D., MPA; Karen Weis, Ph.D., RNC-OB, FAAN; and Heather Fuller.

Delivering babies

2024 births at Sunflower-MOMS hospitals:

• Mitchell County Hospital - 45
• Smith Co. Memorial Hospital - 78
• Gove County Hospital - 81
• Citizens Medical Center - 175