Document Detail

Improving perinatal regionalization for preterm deliveries in a Medicaid covered population: initial impact of the Arkansas ANGELS intervention.
MedLine Citation:
PMID:  21413980     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To examine the factors associated with delivery of preterm infants at neonatal intensive care unit (NICU) hospitals in Arkansas during the period 2001-2006, with a focus on the impact of a Medicaid supported intervention, Antenatal and Neonatal Guidelines, Education, and Learning System (ANGELS), that expanded the consulting capacity of the academic medical center's maternal fetal medicine practice.
DATA SOURCES: A dataset of linked Medicaid claims and birth certificates for the time period by clustering Medicaid claims by pregnancy episode. Pregnancy episodes were linked to residential county-level demographic and medical resource characteristics. Deliveries occurring before 35 weeks gestation (n=5,150) were used for analysis.
STUDY DESIGN: Logistic regression analysis was used to examine time trends and individual, county, and intervention characteristics associated with delivery at hospitals with NICU, and delivery at the academic medical center.
PRINCIPAL FINDINGS: Perceived risk, age, education, and prenatal care characteristics of women affected the likelihood of use of the NICU. The perceived availability of local expertise was associated with a lower likelihood that preterm infants would deliver at the NICU. ANGELS did not increase the overall use of NICU, but it did shift some deliveries to the academic setting.
CONCLUSION: Perinatal regionalization is the consequence of a complex set of provider and patient decisions, and it is difficult to alter with a voluntary program.
Janet M Bronstein; Songthip Ounpraseuth; Jeffrey Jonkman; Curtis L Lowery; David Fletcher; Richard R Nugent; Richard W Hall
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-03-17
Journal Detail:
Title:  Health services research     Volume:  46     ISSN:  1475-6773     ISO Abbreviation:  Health Serv Res     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-07-06     Completed Date:  2011-09-07     Revised Date:  2013-08-20    
Medline Journal Info:
Nlm Unique ID:  0053006     Medline TA:  Health Serv Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1082-103     Citation Subset:  IM    
Copyright Information:
© Health Research and Educational Trust.
University of Alabama at Birmingham University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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MeSH Terms
Age Factors
Arkansas / epidemiology
Health Services Accessibility / statistics & numerical data*
Health Services Research / statistics & numerical data
Infant, Newborn
Intensive Care Units, Neonatal / statistics & numerical data*
Medicaid / statistics & numerical data*
Perinatal Care / statistics & numerical data*
Premature Birth / epidemiology*
Referral and Consultation / statistics & numerical data
Risk Factors
Socioeconomic Factors
Time Factors
United States
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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