The Journal of the Arkansas Medical Society Med Journal Jan 2019 Final 2 | Page 12

EDITORIAL PANEL: Chad T. Rodgers, MD, FAAP | Elena M. Davis, MD, MPH | William L. Mason, MD | Michael Moody, MD | Pramod K. Nelluri, MD | J. Gary Wheeler, MD, MPS
ANGELS: Arkansas’ Telemedical
Approach to High-Risk Obstetrics
P
rior to 2003, Arkansas women
could only access specialty
obstetrical care in the state’s
largest urban centers. Those
living in rural areas did not have easy
access to care, contributing to Arkan-
sas’ high rates of infant mortality, and
maternal morbidity and mortality.
Forty-four percent of Arkansans
live in rural areas compared to the
overall U.S. rate of 19 percent. 1 Sev-
enty-three of the state’s 75 coun-
ties are designated as either full or
partial medically underserved areas. 2
Arkansas has one of the highest rates
of poverty in the nation. It ranks as
one of the worst states for women’s
health, and has higher-than-average
rates of infant mortality and low
birthweight deliveries. 1,3
Lacking access to specialty exper-
tise and fearing possible liabilities
of treating high-risk pregnancies,
Arkansas’ rural family practitioners
and obstetricians often referred such
patients to urban centers staffed with
maternal-fetal medicine and genetic
specialists. This solution resulted in
rural doctors losing many of their
patients and high-risk women having
to travel for needed care. Too often,
these women could not or did not
seek the specialty care they needed.
CURTIS LOWERY, MD
Arkansas Medicaid lacked the
clinical resources to meet increased
demand for high-risk pregnancy
care. In 2003, leaders at the Univer-
sity of Arkansas for Medical Sciences
(UAMS), Arkansas Medicaid and the
Arkansas Medical Society crafted a
successful solution for the state: the
Antenatal and Neonatal Guidelines,
Education and Learning System
(ANGELS), a high-risk obstetrical
telemedicine program. Arkansas
Medicaid appropriated funds to cre-
ate ANGELS to extend maternal-fetal
medicine and genetic expertise to
Medicaid beneficiaries experiencing
high-risk pregnancies and their rural
providers. By bringing expertise
to these providers, local co-man-
agement of high-risk pregnancies
became possible.
The ANGELS team, including
maternal-fetal medicine specialists,
genetic counselors, radiologists,
sonographers, neonatologists,
pediatric subspecialists, dietitians,
social workers and nurses, is available
to women and providers statewide
through telemedicine. The program
has united hospitals with the
collective goal of better managing
Arkansas’ high-risk pregnancies.
ANGELS telemedicine consults are
156 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
offered at 57 health department sites
and 23 hospitals, clinics and regional
centers statewide.
ANGELS is supported by a
24-hour, registered-nurse-staffed
call center providing appointment
assistance, evidence-based guid-
ance for patients and providers and
emergency transport arrangements
for women needing immediate care.
Additionally, ANGELS collaborates
with Arkansas’ physicians to develop
and publish evidence-based obstet-
rical and neonatal guidelines.
Other ANGELS initiatives include:
• Neonatal Resuscitation Program,
an evidence-based approach to
newborn resuscitation education
for health care professionals
• Fetal monitoring courses using the
Association of Women’s Health,
Obstetric and Neonatal Nurses’
approved curriculum
• STABLE (sugar/safe care, tempera-
ture, airway, blood pressure, lab
and emotional support) training
for neonatal critical-care nurses to
establish continuity of care while
stabilizing distressed newborns
• Following Baby Back Home
care-management and home
visiting for families of high-risk
infants, following discharge from a
VOLUME 115