The Journal of the Arkansas Medical Society Med Journal Jan 2019 Final 2 | Page 13

AFMC: A CLOSER LOOK AT QUALIT Y
•
•
•
•
neonatal intensive care unit (NICU)
Obstetrical Simulation Program
drills at rural delivering hospitals
using a high-fidelity mannequin
programmed to simulate obstetri-
cal emergencies
Newborn screening that provides
physician consultations, education
and secondary testing support
for expanded newborn genetic
testing
Statewide infant-safe-sleep edu-
cation and outreach program for
families
Arkansas’ Perinatal Outcomes
Workgroup using Education and
Research (POWER), an ANGELS
initiative, was created to imple-
ment evidence-based practices
in Arkansas’ delivering hospitals.
POWER’s goals are to reduce
maternal morbidity and mortality,
while improving the efficiency and
quality of care.
The United States has the high-
est rate of maternal mortality in the
developed world, 4 with a maternal
mortality rate of 17.3 per 100,000 live
births per year in 2013. 5 Addition-
ally, severe maternal morbidity has
steadily increased nationwide to a
rate of 144 per 10,000. 6
POWER is currently focused on
implementing maternal safety bun-
dles for hypertensive emergencies
and postpartum hemorrhage. More
than half of Arkansas’ 40 delivering
hospitals have implemented safety
bundles. At the request of Arkansas
Medicaid, the AFMC partners with
POWER to educate health care pro-
fessionals about post-birth warning
signs in new mothers. This builds
awareness of best care practices and
may help reduce maternal morbidity
and mortality. As of June 2018, AFMC
has extended this education to nine
Arkansas hospitals and received
enthusiastic reviews.
Arkansas remains one of only 15
states without a maternal mortal-
ity review (MMR) board. To further
improve the state’s standard of
maternal care, ANGELS will support
MMR board development as part of
a multiagency group including other
UAMS departments and the Arkansas
Department of Health. ANGELS will
also expand its telemedicine model
to labor and delivery units statewide.
The ANGELS evaluation and
research team has recognized a
general continuation in improved
birth outcomes for Arkansas’ Med-
icaid-beneficiary population since
ANGELS implementation. Improve-
ments include:
• Decreases in both neonatal and
post-neonatal deaths
• An increased percentage of deliv-
eries in NICU hospitals
• Significant decrease in the rate of
postpartum complications in Med-
icaid deliveries in the two years
following ANGELS’ implementa-
tion; maintaining the lower rate for
six years before increasing in 2014
In 2017, ANGELS’ call center
managed 130,507 calls, had 38,364
calls to their appointment center
and facilitated 501 maternal trans-
ports. In 2015, ANGELS diverted
emergency visits that represented
$1.2 million in cost savings. ANGELS
has not only improved clinical
outcomes, it has provided a means
to promote and manage perina-
tal regionalization to ensure that
complicated deliveries are routed
to the best-equipped hospitals.
The Agency for Healthcare
Research and Quality designated
ANGELS as one of five Medicaid
programs in the nation that should
serve as a model of patient care and
outreach. More than 30 entities, from
the African Congo to New York, have
visited ANGELS to receive hands-on
training and customized advice to
replicate ANGELS among their own
patient and provider populations.
ANGELS’ unique collaboration
will continue to be a model for
institutions that want to implement
telemedicine and women’s health
disparity solutions. For more infor-
mation about ANGELS, call 501-526-
7425 or 866-273-3835. s
Dr. Lowery is chair, UAMS Department
of Obstetrics and Gynecology and
director, ANGELS and Center for
Distance Health.
REFERENCES
1. U. of A. Division of Agriculture. Rural Profile
of Arkansas 2015.
2. U.S. Department of Health and Human
Services. MUA Find. HRSA Data Warehouse
– Shortage Areas. Accessed 6-22-18. https://
datawarehouse.hrsa.gov/tools/analyzers/
MuaFind.aspx.
3. Associated Press. Poverty Rate in Arkansas
Shrinks. U.S. News & World Report. https://
www.usnews.com/news/best-states/arkan-
sas/articles/2017-09-18/poverty-rate-in-ar-
kansas-shrinks. Pub 9-18-17. Accessed
6-22-18.
4. Robeznieks A. U.S. has highest maternal
death rate among developed countries.
Modern Healthcare. Pub 5-6-15. Accessed
6-22-18.-http://www.modernhealthcare.
com/article/20150506/NEWS/150509941.
5. Centers for Disease Control and Prevention.
Reproductive Health. https://www.cdc.gov/
reproductivehealth/maternalinfanthealth/
pmss.html. Pub 11-9-17. Accessed 6-25-18.
6. Centers for Disease Control and Prevention.
Reproductive Health. https://www.cdc.gov/
reproductivehealth/maternalinfanthealth/
severematernalmorbidity.html. Pub. 11-27-
17. Accessed 6-25-18.
AFMC WORKS COLLABORATIVELY WITH PROVIDERS,
COMMUNITY GROUPS AND OTHER STAKEHOLDERS TO
PROMOTE THE QUALITY OF CARE IN ARKANSAS THROUGH
EDUCATION AND EVALUATION. FOR MORE INFORMATION
ABOUT AFMC QUALITY IMPROVEMENT PROJECTS,
CALL 1-877-375-5700 OR VISIT AFMC.ORG.
JANUARY 2019
NUMBER 7
JANUARY 2019 • 157