UAMS IDHI High-Risk Pregnancy Program

Description

Arkansas has many rural communities with high poverty and limited access to specialized maternal-fetal medicine. This lack of access to prenatal care can result in high-risk pregnancies and low birthweight babies.

To improve access to care and the health of newborn babies, the University of Arkansas for Medical Sciences (UAMS) implemented a statewide telehealth program called the IDHI High-Risk Pregnancy Program (formerly known as ANGELS: Antenatal & Neonatal Guidelines, Education and Learning System). This program enhances rural women's access to care by linking patients across the state with physicians and high-risk pregnancy services at UAMS.

Since the program's beginning, there has been an increase over time in the number of preterm babies delivered at hospitals with appropriately staffed neonatal intensive care units (NICUs), supporting improved outcomes for low birthweight infants.

Services offered

The High-Risk Pregnancy Program connects patients and clinicians throughout Arkansas with specialists at UAMS clinics and coordinates efforts to allow for care closer to home. Specifically, the program provides:

• Evidence-based guidelines are developed and disseminated to promote best practices for obstetric and neonatal providers.
• Comprehensive maternal safety bundle simulations, education, and clinical support are available for OB, FM-OB, and ER providers and labor and delivery staff, including high-risk OB teleconferences, OB/GYN grand rounds, and other specialty group sessions.
• The OB Call Center operates 24/7 and is staffed by trained registered nurses who manage a high volume of calls. Services include referrals to the maternal-fetal medicine team, professional nurse triage, and coordination of transfers to UAMS for high-risk obstetrical care. The call center supports a comprehensive OB case management program, providing condition-specific education, post-delivery care, and perinatal bereavement follow-up.
• Maternal-fetal and newborn case management is facilitated through the Arkansas Fetal Diagnosis and Management (AFDM) team, the Following Baby Back Home team, and the Telenursery team led by a neonatologist.
• Telemedicine networks and clinics extend services to fully or partially medically underserved communities. The High-Risk Pregnancy Program provides access to obstetrical specialists and a comprehensive high-risk obstetrical care team virtually. Providers across the state can refer patients for targeted ultrasounds, genetic counseling, and management or co-management for many high-risk conditions.
• The Women's Mental Health Program (WMHP) at the Psychiatric Research Institute (PRI) provides specialized psychiatric evaluations and medication management for pregnant or postpartum individuals and consultations for those considering pregnancy. The program also includes acute inpatient psychiatric care within the Women's Inpatient Unit.
• The Evaluation and Research Team facilitates the High-Risk Pregnancy Program to determine its effectiveness. This is achieved with Arkansas Department of Human Services (DHS) and Arkansas Department of Health (ADH) data.

The High-Risk Pregnancy Program supports statewide provider education through teleconferences and guidelines:

• Guidelines for best practices support healthcare providers statewide and are reviewed and updated annually by experts.
• Little Patients, Big Topics (LPBT) is a weekly pediatric educational conference to share education, research, innovation, and best practices for clinicians across the state through the use of teleconferencing.
• ONE Team allows nurses to facilitate evidence-based content and earn continuing education units via telemedicine.
• High-Risk Obstetrical Teleconferences provide a collaborative forum joining healthcare providers across the state to present and review obstetrical cases to support best practices.
• OB/GYN Grand Rounds Teleconferences provide healthcare professionals a chance to present OB/GYN and women's health topics.
• Fetal Anomalies Interdisciplinary Management (FAIM) Teleconferences review congenital anomalies and new management and treatment techniques.
• POWER (Perinatal Outcomes Workgroup using Education and Research) works with hospital teams to facilitate maternal safety bundle implementation, address barriers to evidence-based practice, and decrease maternal morbidity and mortality throughout Arkansas.

Here are other healthcare tools:

• Fetal monitoring courses are offered online and in person by the Outreach Education Team.
• Neonatal Resuscitation Program (NRP) courses are offered.
• Obstetric Patient Safety workshops and training focus on best practices for obstetric emergencies during pregnancy or postpartum period.
• OB Simulation fulfills educational and training needs of healthcare professionals through obstetric simulations and drills.
• The Sugar, Temperature, Airway, Blood pressure, Lab work, and Emotional (S.T.A.B.L.E.) Program is the most widely distributed and implemented neonatal education program, and it educates and trains licensed healthcare professionals working in neonatal critical care.
• Arkansas Fetal Diagnosis and Management (AFDM) is a multidisciplinary program for pregnant patients and their families who have been given a diagnosis of a fetus with a congenital anomaly or genetic disease.
• The Perinatal Opiate Project provides evaluation and individual treatment plans for opiate dependency during pregnancy.
• The Angel Eye program allows parents to watch, take photos of, and speak to their infant in real time from any computer when the newborn is in the intensive care unit.
• Telenursery conducts nursery census and weekly rounds with 26 of the state's outlying hospital nurseries and provides neonatal and subspecialty education, consultations, follow-up, and back transport of infants to their local hospital and community.
• A statewide newborn screening program provides physician consultations, education, and secondary testing support for expanded newborn genetic testing.
• WIN (Web-Based Instruction on Nutrition) provides maternity nutrition education.
• Diabetes Care in Pregnancy (via telemedicine or in person) is provided by the UAMS Obstetrical Center for Management of Hyperglycemia in Pregnancy.

Results

The program has enhanced access to specialty care for rural individuals in Arkansas and has resulted in:

• Decreased distance that many individuals in Arkansas travel to be seen by an obstetric expert via telemedicine by equipping over 30 rural sites with needed technology and using the patient's home as a place of service
• Development of more than 170 obstetrical and neonatal guidelines for rural providers
• An increase in Medicaid beneficiaries delivering premature or low birthweight babies at facilities with appropriately staffed NICU services
• Fewer complications for high-risk individuals and their babies
• Cost savings for Arkansas' Medicaid program due to fewer complications
• A total of 2,171 telemedicine visits in fiscal year 2025 for expectant mothers
• 1,635 tele-ultrasounds conducted in fiscal year 2025
• 85 high-risk OB consults in fiscal year 2025
• 80,662 calls answered, with 7,342 nurse triage calls in fiscal year 2025
• 174 back transport to rural hospitals in fiscal year 2025 for mothers and infants who delivered at urban facilities but could be clinically managed closer to home
• 117 tele-fetal-echocardiography visits in fiscal year 2025

From 2024 to 2025, 54 patients reported their satisfaction with telehealth services:

• 93% of patients reported they were happy with their telehealth visits
• Over 86% of patients found that their providers usually or always explained things in a way that was understood
• 90% of patients said scheduling their telehealth appointment was easy
• 60% of patients said they liked telehealth services since they were not required to travel far to the appointment
• 17% of patients said they liked telehealth services since they did not have to arrange child care
• 62% of patients traveled less than 30 miles, with 6% reporting no travel to attend their telehealth appointment
• 56% of patients would have had to travel over 70 miles for their appointment if telehealth weren't an option
• 66% of patients reported that it would have cost them more than $75 if they didn't have a telehealth option, with over 40% reporting costs of more than $150

The program was honored with the American Telemedicine Association's President's Award for Innovation in Remote Healthcare in 2007 and its Institutional Award for the Advancement of Telemedicine in 2011. The program was also a core member of the Agency for Healthcare Research and Quality (AHRQ) Medicaid Care Management Learning Network in 2005. The program contributed to the designation of UAMS as the South Central Telehealth Resource Center (SCTRC) by the Health Resources and Services Administration (HRSA) and to the designation of UAMS as a HRSA Telehealth Focused Rural Health Research Center.

For more detailed information on the program's results:

Sung, Y-S., Zhang, D., Eswaran, H., & Lowery, C.L. (2021). Evaluation of a Telemedicine Program Managing High-Risk Pregnant Women with Pre-Existing Diabetes in Arkansas's Medicaid Program. Seminars in Perinatology, 45(5), 151421. Article Abstract

Rhoads, S.J., Eswaran, H., Lynch, C.E., Ounpraseuth, S.T., Magann, E.F., & Lowery, C.L. (2018). High-Risk Obstetrical Call Center: a Model for Regions with Limited Access to Care. The Journal of Maternal-Fetal & Neonatal Medicine, 31(7), 857-865. Article Abstract

Bronstein, J.M., Ounpraseuth, S., & Lowery, C.L. (2020). Improving Perinatal Regionalization: 10 Years of Experience with an Arkansas Initiative. Journal of Perinatology, 40(11), 1609-1616. Article Abstract

Hughes, D.S., Ussery, D.J., Woodruff, D.L., Sandlin, A.T., Kinder, S.R., & Magann, E.F. (2015). The Continuing Antenatal Management Program (CAMP): Outpatient Monitoring of High-Risk Pregnancies. Keeps Patients Safe, Costs Low and Care Nearby. Sexual & Reproductive Healthcare, 6(2), 108-109. Article Abstract

Lowery, C.L., Bronstein, J.M., Benton, T.L., & Fletcher, D.A. (2014). Distributing Medical Expertise: the Evolution and Impact of Telemedicine in Arkansas. Health Affairs (Millwood), 33(2), 235-243. Article Abstract

Long, M.C., Angtuaco, T., & Lowery, C. (2014). Ultrasound in Telemedicine: Its Impact in High-Risk Obstetric Health Care Delivery. Ultrasound Quarterly, 30(3), 167-172. Article Abstract

Kim, E.W., Teague-Ross, T.J., Greenfield, W.W., Williams, D.K., Kuo, D., & Hall, R.W. (2013). Telemedicine Collaboration Improves Perinatal Regionalization and Lowers Statewide Infant Mortality. Journal of Perinatology, 33(9), 725-730.

Ounpraseuth, S., Gauss, C.H., Bronstein, J., Lowery, C., Nugent, R., & Hall, R. (2012). Evaluating the Effect of Hospital and Insurance Type on the Risk of 1-Year Mortality of Very Low Birth Weight Infants: Controlling for Selection Bias. Medical Care, 50(4), 353-360. Article Abstract

Magann, E.F., Bronstein, J., McKelvey, S.S., Wendel, P., Smith, D.M., & Lowery, C.L. (2012). Evolving Trends in Maternal Fetal Medicine Referrals in a Rural State Using Telemedicine. Archives of Gynecology and Obstetrics, 286(6), 1383-92. Article Abstract

Bronstein, J.M., Ounpraseuth, S., Jonkman, J., Fletcher, D., Nugent, R.R., McGhee, J., & Lowery, C.L. (2012). Use of Specialty OB Consults during High-Risk Pregnancies in a Medicaid-Covered Population: Initial Impact of the Arkansas ANGELS Intervention. Medical Care Research Review, 69(6), 699-720. Article Abstract

Wingate, M.S., Bronstein, J., Hall, R.W., Nugent, R.R., & Lowery, C.L. (2012). Quantifying Risks of Preterm Birth in the Arkansas Medicaid Population, 2001-2005. Journal of Perinatology, 32(3), 176-193. Article Abstract

Bronstein, J.M., Ounpraseuth, S., Jonkman, J., Lowery, C.L., Fletcher, D., Nugent, R.R., & Hall, R.W. (2011). Improving Perinatal Regionalization for Preterm Deliveries in a Medicaid Covered Population: Initial Impact of the Arkansas ANGELS Intervention. Health Services Research Journal, 46(4), 1082-1103. Article Abstract

Bibliography of articles

Challenges

This program overcame implementation barriers by identifying "telemedicine champions" in rural communities, in most cases family practice or obstetrical providers who advocated for the use of the program's telemedicine services within their local hospital.

These champions are essential for success, as some providers may fear that the telemedicine practice will infringe on their local practice. The telemedicine champions can act as trusted agents to demonstrate that telemedicine will actually enhance local care, creating an environment of co-management for complex patients.

To the extent possible, the program's telemedicine model seeks to keep the patient in the care of their local provider, except when it is necessary for the patient to see a specialist face-to-face. Having community telemedicine champions combined with a strong program outreach component was essential for the program to show community providers that their practice would be enhanced by telemedicine, not replaced by it.

Telemedicine champions are also essential in navigating local or organizational barriers, helping establish relationships with local technologists, and managing community relations that impact program adoption. This helps ensure the program serves all patients in these communities regardless of language, health literacy, or location.

Replication

This program and its evaluations show the importance of reaching out to rural providers to encourage referrals. One 2012 study found that while referrals to similar programs almost doubled for Medicaid recipients between 2001 and 2006, rates of referrals still varied widely among providers. It is important for agencies wishing to replicate the High-Risk Pregnancy Program to include providers, health departments, and other interested parties in the planning and design of interventions in order to increase their acceptance of and participation in such programs. Additional tips for replication include having partners in different organizations around the state, including local health departments.

As a Telehealth Resource Center, UAMS provides telemedicine training to organizations within the south-central region of the United States to replicate the High-Risk Pregnancy Program and other telemedicine interventions in their communities. The High-Risk Pregnancy Program hosts other programs and universities at the training center. You can contact the program to learn more.

Contact Information