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ANGELS Program Evaluation

The Evaluation Team continuously monitors and evaluates the ANGELS program to determine areas of success and where improvements can be made.  Toward that end, we have collected Medicaid claims data, birth certificate data and hospital discharge records from 2001, two years prior to the implementation of ANGELS, up to the most recent year.

The Evaluation Team looks at the entire pregnancy of each mother, including the postpartum period, matches that mother to her baby and then appends the claims for the first year of that baby’s life to create an entire episode of pregnancy and the resulting child.  Using this method, the evaluation team has been able to determine trends, such as a decrease in the rate neonatal deaths during the time when ANGELS has been in place and an increase in the portion of deliveries in hospitals with a NICU.

As the Evaluation Team continues to compile and examine this rich source of data, findings are shared with the medical and academic community.  The following is a partial list of publications that have already been produced with the help of the evaluation team:

  1. Lowery, C., Bronstein, JM, McGhee, J., Ott; R., Reece, E.A.,  Mays, G.P., ANGELS & University of Arkansas for Medical Sciences Paradigm for Distant Obstetrical Care Delivery, American Journal of Obstetrics and Gynecology. 2007 Jun;196(6):534.e1-9  http://www.sciencedirect.com/science/article/pii/S0002937807001007
  2.  Bronstein, J.M., Lomatsch, C.T., Fletcher, D., Wooten, T., Lin, T.M., Nugent, R., Lowery, C.L., Issues and Biases in Matching Medicaid Pregnancy Episodes to Birth Certificate Data:  The Arkansas Experience. , Maternal and Child Health Journal 2009;13:250-259.  http://link.springer.com/article/10.1007%2Fs10995-008-0347-z
  3. Bronstein, J.M., Ounpraseuth, S.T.,  Jonkman, J.,Lowery, C.L.,  Fletcher, D.,  Nugent, R.R, Hall, R.W. Improving Perinatal Regionalization for Preterm Deliveries in a Medicaid Covered Population:  Initial Impact of the Arkansas ANGELS Intervention  Health Services Research 2011; 46(4):1082-1103. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165179/
  4. Nugent, R.R. Golden, W.W., Hall, R.W., Bronstein, J.M., Grimes, D., Lowery, C.L.  Locations and outcomes of premature births in Arkansas  Journal of the Arkansas Medical Society, 2011; 107(12):258-9. https://www.ncbi.nlm.nih.gov/pubmed/21667683
  5. Ounpraseuth, S.T.,  Gauss, C.H., Bronstein, J., Lowery, C., Nugent, R.,  Hall, R.  Evaluating the Effect of Hospital and Insurance Type on the Risk of 1-Year Mortality of Very Low Birth Weight Infants: Using Propensity Scores to Control for Selection Bias. Medical Care 2012;50(4):353-360  https://www.ncbi.nlm.nih.gov/pubmed/22422056
  6. Bronstein, J.M., Ounpraseuth, S.,  Jonkman, J.,  Fletcher, D.,  Nugent, R. R.,  McGhee, J., Lowery, C.L., Use of Specialty OB consults during high risk pregnancies in a Medicaid Covered Population:  Initial Impact of the Arkansas ANGELS intervention.  Medical Care Research and Review 2012 (Dec) 69(6):699-720http://mcr.sagepub.com/content/69/6/699.long
  7.  Lowery, CL, Bronstein, JM, Benton, TL, Fletcher, DA.  Distributing medical expertise: the evolution and impact of telemedicine in Arkansas.  Health Affairs 2014 (Feb) 33(2): 235-43  http://content.healthaffairs.org/content/33/2/235.long
  8. Ounpraseuth, S, Bronstein, JM,  Gauss,CH, Wingate,MS,  Hall,RW, Nugent, RR, Time Trends and Payer Differences in Lengths of Initial Hospitalization for Preterm Infants, Arkansas 2004-2010.   American Journal of Perinatology 2015; 32(1):33-42  https://www.ncbi.nlm.nih.gov/pubmed/24792767