A two-period assessment of changes in specialist contact in a high-risk pregnancy telemedical program.

The purpose was to examine the organizational impact of a state-wide high-risk pregnancy telemedical system, Antenatal and Neonatal Guidelines, Education and Learning System (ANGELS), after the first year of its roll out. The focus is on several aspects of system organization, including the volume and diversity of patient-based telemedical consultations and weekly telemedical case discussions, telephone consultations, and changes in the pattern of birth-related patient transports. Individual data on patient transports and associated hospital days, provider-specialist telephone calls, and telemedical consultations were collected for two time periods: December 2002-May 2003 (prior to initiation of ANGELS), and December 2003-May 2004 (postinitiation of ANGELS). Different statistical tests were constructed to compare the two periods as appropriate. Significant increases were observed in the volume and geographic diversity of telemedical consultations and the volume of telephone consultations. There was a moderate, but nonsignificant decrease in the number of maternal transports to University of Arkansas School of Medical Sciences (UAMS), and the average length of stay decreased. The type of specialist-provider and specialist-patient contact has changed as the ANGELS high-risk pregnancy telemedical system has evolved over the first year. We conclude that the rollout of the ANGELS program is changing the shape of high-risk patient care in Arkansas, and we attribute that to an evolving collegial network between specialists and generalists.