Use of specialty OB consults during high-risk pregnancies in a Medicaid-covered population: initial impact of the Arkansas ANGELS intervention.

This study examines the impact of a Medicaid-supported intervention (Antenatal and Neonatal Guidelines, Education and Learning System) to expand a high-risk obstetrics consulting service on the use of specialty consults between 2001 and 2006. Using a Medicaid claims-birth certificate data set, we find a decline over time in use of specialty consults for lower risk diagnoses and a shift to remote modalities for contact. Local physician participation in grand rounds via teleconference was associated both with specialty contact and use of remote modalities. Local physician use of a Call Center service was also associated with patient specialty contact. Expansion of telemedicine remote sites did not increase the likelihood of contact but was associated with the shift toward remote modalities. Specialty consult use and modality were influenced by the care context of the patient, particularly level of pregnancy risk, the specialty of the primary prenatal care provider, the timing of her prenatal care, and her ethnicity and education level.

ANGELS and University of Arkansas for Medical Sciences paradigm for distant obstetrical care delivery.

OBJECTIVE: This article describes the process by which the Arkansas Medicaid Program, the University of Arkansas for Medical Sciences (the state's only academic health center), and Arkansas' practicing physicians are collaborating to improve the process of perinatal regionalization by providing access to expertise, education, and support of maternal-fetal medicine specialists. The described ANGELS model encourages replication among other programs that wish to improve perinatal regionalization attempts in their service areas. STUDY DESIGN: Through this unique collaboration, ANGELS is composed of 5 distinctive elements: a statewide telemedicine and clinic network, an education and support program for obstetric providers, case management services, a 24-hour Call Center, and an evidence-based guidelines development and distribution network. RESULTS: Since Arkansas has undertaken perinatal regionalization, technology has allowed the state's only group of board-certified maternal-fetal medicine specialists, located centrally in Little Rock, to provide real-time clinical support to physicians, as well as consultation or direct care to patients statewide. CONCLUSION: ANGELS' continued efforts have the potential to significantly improve perinatal care in rural areas throughout the state, while the cost of maternal and fetal health care could decline. The program's design, although unique, can be replicated elsewhere to encourage perinatal regionalization.