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Improving perinatal regionalization: 10 years of experience with an Arkansas initiative

Journal of Perinatology volume 40, pages 1609–1616 (2020)Cite this article

Subjects

Abstract

Objective

To examine the impact of Antenatal and Neonatal Guidelines, Education and Learning Systems (ANGELS) on neonatal intensive care unit (NICU) preterm delivery rates.

Study design

In this longitudinal observational study, linked vital records and Medicaid claims records for 29,124 preterm births (April 2001–December 2012) to Medicaid covered women were used to examine factors predicting whether deliveries occurred at hospitals with neonatology-staffed NICUs. The factors associated with delivery are estimated and compared for baseline and three post-implementation periods.

Results

Rates for NICU preterm deliveries increased from 28 to 37% over the time period. Compared to baseline, adjusted NICU delivery rates in the middle and late implementation periods were statistically significant (p < 0.001). Negative impacts of long travel times were reduced, while impacts of obstetrician prenatal care changed from negative to positive association.

Conclusion

Findings validate the ANGELS initiative premise: academic specialists, working with community-based care providers, can improve perinatal regionalization.

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Acknowledgements

The ANGELS initiative is funded through an annual Medicaid contract with the Arkansas Department of Human Services.

Funding

This study was funded by a Medicaid contract and is supported by the Arkansas Division of Medical Assistance with the collaboration of the Arkansas Department of Health.

Author information

Authors and Affiliations

  1. University of Alabama at Birmingham, School of Public Health, Birmingham, AL, USA

    Janet M. Bronstein

  2. University of Arkansas for Medical Sciences, College of Public Health, Little Rock, AR, USA

    Songthip Ounpraseuth

  3. Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Curtis L. Lowery

Authors
  1. Janet M. Bronstein
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  2. Songthip Ounpraseuth
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  3. Curtis L. Lowery
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Contributions

All authors contributed to the composition and submission of this manuscript. JB and CL linked Medicaid claims and prepared the data for analysis. SO led the analysis of the data. JB and CL interpreted the data analysis.

Corresponding author

Correspondence to Janet M. Bronstein.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Bronstein, J.M., Ounpraseuth, S. & Lowery, C.L. Improving perinatal regionalization: 10 years of experience with an Arkansas initiative. J Perinatol 40, 1609–1616 (2020). https://doi.org/10.1038/s41372-020-0726-x

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  • DOI: https://doi.org/10.1038/s41372-020-0726-x

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