A qualitative comparative analysis of the conditions affecting early maternal transfer patterns

In Arkansas, almost all of the high-risk-pregnancy resources are concentrated in a single place, at the University of Arkansas for Medical Sciences (UAMS). During the 6-month period before a telemedicine programme started, there were five operational telemedicine sites in the state, and during the subsequent 12-month period, there were 13 telemedicine sites in operation. Data were gathered on birth-related transfers during the two periods. Qualitative comparative analysis (QCA) was used to assess the effect of different combinations of telemedical and hospital-level resources on the timing of maternal transfers. Early (pre-33-week gestational age) maternal transfers occurred in period 1 (before the telemedicine programme started), only from areas with level-2 hospital resources and no telemedicine access; early transfers also occurred in period 2 from areas with level-2 hospital resources and either telemedicine access or no telemedicine access. We conclude that combinations of resources affect physician decisions regarding transfer and that QCA is a useful tool for examining the growth and development of telemedicine systems.