UAMS, Arkansas Department of Human Services Launch Nation’s First “ANGELS” Program to Reduce Premature Births

By todd

UAMS Chancellor I. Dodd Wilson, M.D. and DHS Director Kurt Knickrehm announced creation of the “ANGELS” service, with $9.5 million in annual funding from the federal Medicaid program through DHS, today. The program’s name is an acronym for Antenatal and Neonatal Guidelines, Education, and Learning System. UAMS high-risk pregnancy experts worked with the DHS Arkansas Medicaid program to obtain federal Medicaid funds for the project.

“We anticipate considerable savings for the state from reducing the number of medically fragile babies – and that doesn’t consider the savings in pain and suffering by the children and their families,” Curtis L. Lowery, M.D., ANGELS director and director of maternal-fetal medicine at UAMS, said.

“Since the state Medicaid program pays for nearly half of all births in Arkansas, we have a heavily vested interest in keeping moms and babies healthy,” said DHS Director Kurt Knickrehm. “As the state’s largest insurer and as stewards of public dollars, we must strive to ensure that our services have a positive impact on people’s lives while reducing the cost to the State.”

“The Arkansas Medical Society (AMS) is pleased to support this innovative program to deliver the newest information about maternal-fetal medicine to obstetrical providers in the state,” Brenda Powell, M.D., of Hot Springs, secretary of the AMS, said.

Hope and Jimmy Goodwin of Vilonia, Ark., whose quadruplets were born six weeks prematurely, two of them with twin-twin transfusion syndrome, praised the UAMS maternal-fetal medicine program for saving their babies from serious difficulties at birth. “Matthew, Lauren, Elijah and Gabriel are 14 months old now and doing very well,” Mrs. Goodwin said.

The “ANGELS” service will include clear guidelines for diagnosing and treating high-risk pregnancies, continuing medical education for Arkansas obstetricians and family practice physicians, and procedures for referring pregnant women with severe medical complications to UAMS for specialized care. Obstetrical and neonatal health care providers will have around-the-clock access to experts in high-risk pregnancy at UAMS.

“The Arkansas Medicaid program has made it possible for UAMS to work even more closely with obstetrical care providers across Arkansas,” Lowery said. “This is an enhancement of the great relationship UAMS has enjoyed with Arkansas’ obstetricians and family practice physicians. Thanks to the Arkansas Medicaid program, we’re able to work with local obstetricians to create a triage system that we believe will become a national model.” Triage is the process of ranking patients according to the severity of their illnesses and assigning them to different levels of care.

The guidelines for obstetricians will reflect “evidence-based medicine,” the term for medical procedures that are based on the results of large scientific studies of particular treatments. The maternal-fetal medicine specialists in the UAMS College of Medicine will summarize and share the results of significant studies with Arkansas’ obstetricians and family practice physicians.

“This program is just one part of the evidence-based medical approach the Department of Human Services is taking to improve the health of Arkansans,” Knickrehm said. “We are excited to work with UAMS to create a model other states can follow.”

“Practicing physicians often don’t have the time to read the hundreds of medical articles published each month and adapt their methods in response to what they learn. They spend all of their time taking care of their patients,” Lowery said. “We’re going to give them the essential information they need in a practical format that will allow them to identify and treat high-risk pregnancy cases and manage newborn care in a state-of-the-art fashion.”

Lowery predicts the service will reduce the state’s costs for Medicaid-covered pregnancy care and long-term care of children born with serious health problems such as prematurity, low birth-weight, birth defects or brain damage. The number of women in Arkansas who are eligible for Medicaid coverage of prenatal care has increased from approximately 14,800 last year to approximately 22,200, thanks to an expansion of the Arkansas Medicaid program funded by part of the state’s share in the nationwide tobacco settlement.

The Arkansas Medicaid program currently pays for full-time nursing care for about 134 medically fragile children, many of whom have health problems as a result of high-risk pregnancies, at an annual cost of $13 million.

The program also could result in fewer malpractice suits against physicians, Lowery says. UAMS will evaluate the ANGELS system by analyzing costs and outcomes for patients of participating physicians.

UAMS already provides advice and assistance to Arkansas obstetricians through a network of interactive video connections that allow physicians and their patients in nine Arkansas communities to consult UAMS specialists. The Reproductive Genetics Program at UAMS assists more than 2,000 patients annually with amniocentesis, genetic counseling, high-risk ultrasound, fetal echocardiography and video-based clinics. UAMS also provides continuing medical education classes for obstetricians as well as many other physicians.

Lowery is an associate professor in the Department of Obstetrics and Gynecology in the UAMS College of Medicine. He is a prominent researcher in maternal-fetal medicine and has pioneered a device to measure fetal brain activity. His device, called SARA, is a unique scanner that detects fetal brain activity in response to flashes of light transmitted through the mother’s abdomen. With refinement, SARA may help physicians detect and prevent fetal brain damage resulting from maternal hypertension, diabetes, and other conditions.