Address correspondence to Janet M. Bronstein, Ph.D., School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL 35294; e-mail: email@example.com. Songthip Ounpraseuth, Ph.D., is with Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR. Jeffrey Jonkman, Ph.D., is with the Department of Mathematics and Statistics, Grinnell College, Grinnell, IA. Curtis L. Lowery, M.D., David Fletcher, M.B.A., and Richard R. Nugent, M.D., M.P.H., are with Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR. Richard W. Hall, M.D., is with the Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR.
Improving Perinatal Regionalization for Preterm Deliveries in a Medicaid Covered Population: Initial Impact of the Arkansas ANGELS Intervention
Article first published online: 17 MAR 2011
© Health Research and Educational Trust
Health Services Research
Volume 46, Issue 4, pages 1082–1103, August 2011
How to Cite
Bronstein, J. M., Ounpraseuth, S., Jonkman, J., Lowery, C. L., Fletcher, D., Nugent, R. R. and Hall, R. W. (2011), Improving Perinatal Regionalization for Preterm Deliveries in a Medicaid Covered Population: Initial Impact of the Arkansas ANGELS Intervention. Health Services Research, 46: 1082–1103. doi: 10.1111/j.1475-6773.2011.01249.x
- Issue published online: 5 JUL 2011
- Article first published online: 17 MAR 2011
- preterm births;
- perinatal regionalization;
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.