title: Improving perinatal regionalization for preterm deliveries in a Medicaid covered population: initial impact of the Arkansas ANGELS intervention.
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Perinatal regionalization is the consequence of a complex set of provider and patient decisions, and it is difficult to alter with a voluntary program.
authors.affiliation: University of Alabama at Birmingham University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Bronstein
authors.forename: Songthip
authors.initials: S
authors.lastname: Ounpraseuth
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Jonkman
authors.forename: Curtis L
authors.initials: CL
authors.lastname: Lowery
authors.forename: David
authors.initials: D
authors.lastname: Fletcher
authors.forename: Richard R
authors.initials: RR
authors.lastname: Nugent
authors.forename: Richard W
authors.initials: RW
authors.lastname: Hall
mesh_terms: D000367:Age Factors; D001131:Arkansas / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008484:Medicaid / Q000706:statistics & numerical data*; D018743:Perinatal Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States