Long Megan Chang, Angtuaco Teresita, Lowery Curtis
Departments of *Radiology and †Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR.
Ultrasound Q. 2014 Sep;30(3):167-72. doi: 10.1097/RUQ.0000000000000073.
The aim of this study was to determine the impact of Antenatal and Neonatal Guidelines, Education, and Learning System (ANGELS), a statewide telemedicine project, on health care delivery to patients with high-risk pregnancies in Arkansas.
With institutional review board approval, a Health Insurance Portability and Accountability Act-compliant retrospective review, in which the requirement for informed patient consent was waived, was performed. The population studied is the Arkansas maternal Medicaid population. Data for evaluation were collected from maternal Medicaid claims, ANGELS administrative records, and birth records from the Arkansas Vital Statistics record system. Data collected from before the inception of ANGELS (2001-2003) were compared with data collected after the inception of ANGELS (2004-2007).Antenatal and Neonatal Guidelines, Education, and Learning System is a multidisciplinary, multifaceted telemedicine program designed in Arkansas to enhance high-risk obstetric health care delivery across the state. An essential component of the program is real-time interactive targeted level II ultrasound examination of patients.
Since the inception of the ANGELS program in 2003, a growing number of telemedicine consultations and real-time ultrasound examinations are being performed every year. The number and percentage of high-risk pregnancies identified each year show a slight decrease since inception of the ANGELS program, and findings suggest that identification of high-risk pregnancies is shifting from the second trimester to the first trimester, but trends vary over time.
Antenatal and Neonatal Guidelines, Education, and Learning System has created a telemedicine network across the state that has made possible, among many other things, access to real-time level II ultrasound examinations and consultations. This program has ultimately led to improved prenatal access across the state.
本研究旨在确定全州远程医疗项目“产前与新生儿指南、教育及学习系统”（ANGELS）对阿肯色州高危妊娠患者医疗服务的影响。
经机构审查委员会批准，进行了一项符合《健康保险流通与责任法案》的回顾性研究，其中患者知情同意的要求被豁免。研究人群为阿肯色州的孕产妇医疗补助人群。评估数据收集自孕产妇医疗补助理赔记录、ANGELS管理记录以及阿肯色州生命统计记录系统的出生记录。将ANGELS启动前（2001 - 2003年）收集的数据与ANGELS启动后（2004 - 2007年）收集的数据进行比较。产前与新生儿指南、教育及学习系统是阿肯色州设计的一个多学科、多层面的远程医疗项目，旨在加强全州高危产科医疗服务。该项目的一个重要组成部分是对患者进行实时交互式靶向二级超声检查。
自2003年ANGELS项目启动以来，每年进行的远程医疗会诊和实时超声检查数量不断增加。自ANGELS项目启动以来，每年识别出的高危妊娠数量和百分比略有下降，研究结果表明高危妊娠的识别正从孕中期转向孕早期，但趋势随时间变化。
产前与新生儿指南、教育及学习系统在全州建立了一个远程医疗网络，除其他诸多方面外，该网络使得进行实时二级超声检查和会诊成为可能。该项目最终改善了全州的产前医疗服务可及性。
