title: Use of specialty OB consults during high-risk pregnancies in a Medicaid-covered population: initial impact of the Arkansas ANGELS intervention.
abstract: This study examines the impact of a Medicaid-supported intervention (Antenatal and Neonatal Guidelines, Education and Learning System) to expand a high-risk obstetrics consulting service on the use of specialty consults between 2001 and 2006. Using a Medicaid claims-birth certificate data set, we find a decline over time in use of specialty consults for lower risk diagnoses and a shift to remote modalities for contact. Local physician participation in grand rounds via teleconference was associated both with specialty contact and use of remote modalities. Local physician use of a Call Center service was also associated with patient specialty contact. Expansion of telemedicine remote sites did not increase the likelihood of contact but was associated with the shift toward remote modalities. Specialty consult use and modality were influenced by the care context of the patient, particularly level of pregnancy risk, the specialty of the primary prenatal care provider, the timing of her prenatal care, and her ethnicity and education level.
authors.affiliation: School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35294, USA. jbronstein@uab.edu
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: David
authors.initials: D
authors.lastname: Fletcher
authors.forename: Richard R
authors.initials: RR
authors.lastname: Nugent
authors.forename: Judith
authors.initials: J
authors.lastname: McGhee
authors.forename: Curtis L
authors.initials: CL
authors.lastname: Lowery
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D001131:Arkansas; D005260:Female; D006301:Health Services Needs and Demand / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D008484:Medicaid / Q000706:statistics & numerical data*; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D015397:Program Evaluation; D012017:Referral and Consultation / Q000458:organization & administration / Q000706:statistics & numerical data*; D017216:Telemedicine / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult