# The impact of and path forward for telehealth on reducing disparities in severe maternal morbidity: A community engaged mixed-methods study

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2024 · $707,192

## Abstract

PROJECT SUMMARY
The maternal mortality rate in the United States (US) is the highest among high-income countries and has
been steadily rising in recent years. Near misses for maternal mortality, including both physical health
indicators captured by severe maternal morbidity (SMM) and mental health near misses such as suicidality and
overdose (hereafter, SMM+), are also increasing among birthing individuals. Racial and other disparities in
maternal mortality and SMM+ are widening. Telehealth utilization increased dramatically in response to the
COVID-19 pandemic and has great potential to reduce SMM+ and SMM+ disparities through increasing
healthcare access and utilization, patient experience, and quality of care. However, there is little data on
maternal safety outcomes like SMM+, whether telehealth could reduce or exacerbate disparities in SMM+, and
how telehealth can be optimized with the goal of reducing SMM+ and SMM+ disparities. This project will
determine the impact of telehealth on SMM+ and SMM+ disparities and develop multidisciplinary clinical and
community consensus guidelines for how telehealth can be implemented to address equity issues and reduce
disparities in SMM+. We will apply a mixed-methods approach, conducting novel causal inference analyses of
a national Medicaid claims database, the largest US health insurance provider during pregnancy (>40% of
births; 65% of births to Black individuals), and qualitative work centered in Philadelphia, a city with a high
maternal mortality rate and one of the country's only local maternal mortality review committees. We will form a
community advisory board (CAB) that includes multidisciplinary stakeholders and lived experience experts to
provide substantial input on all aspects of the proposal. Specifically, we will estimate effects of hybrid
telehealth versus in-person only prenatal and postpartum care strategies and state policies expanding
coverage for telehealth modalities on SMM+ and SMM+ disparities using a novel trial emulation framework
(Aim 1); identify barriers and facilitators to implementing telehealth care with the goal of reducing SMM+ and
SMM+ disparities (Aim 2); and develop and disseminate best practice recommendations for using telehealth to
detect early warning signs of SMM+ (Aim 3). Successful completion of this work will fill critical gaps in
knowledge about the safety, effectiveness and equitableness of maternity telehealth care and how telehealth
can be leveraged to reduce maternal health disparities. Through sustained partnership with a CAB and
dissemination of best practice recommendations, our methodologically innovative project will inform care,
guidelines, and policy in Philadelphia and nationally. By sharing our project's key findings, methods and
software code, we will generate a community-driven research agenda and cultivate collaborators for future
research using our database and CAB.

## Key facts

- **NIH application ID:** 10774621
- **Project number:** 1R01HD113685-01
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Ellen Christina Caniglia
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $707,192
- **Award type:** 1
- **Project period:** 2024-09-15 → 2029-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10774621

## Citation

> US National Institutes of Health, RePORTER application 10774621, The impact of and path forward for telehealth on reducing disparities in severe maternal morbidity: A community engaged mixed-methods study (1R01HD113685-01). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10774621. Licensed CC0.

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