Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Access to Provider through Hotline HOSPITAL Continuing Education of Hospital Providers POPULATION-BASED SYSTEMS INTER-HOSPITAL SYSTEMS Maternal/In-Utero Transport Systems STATE Policy/Guideline (State) Consultation Systems (Inter-Hospital Systems) Consultation Systems (Hospital) Telemedicine Systems (Inter-Hospital Systems) Telemedicine Systems (Hospital)

Intervention Description: To examine the factors associated with delivery of preterm infants at neonatal intensive care unit (NICU) hospitals in Arkansas during the period 2001–2006, with a focus on the impact of a Medicaid supported intervention, Antenatal and Neonatal Guidelines, Education, and Learning System (ANGELS), that expanded the consulting capacity of the academic medical center's maternal fetal medicine practice.

Intervention Results: Perceived risk, age, education, and prenatal care characteristics of women affected the likelihood of use of the NICU. The perceived availability of local expertise was associated with a lower likelihood that preterm infants would deliver at the NICU. ANGELS did not increase the overall use of NICU, but it did shift some deliveries to the academic setting.

Conclusion: Perinatal regionalization is the consequence of a complex set of provider and patient decisions, and it is difficult to alter with a voluntary program.

Study Design: Time trend analysis

Setting: All Arkansas hospitals Five level III hospitals from 2001- 2005, six in 2006

Population of Focus: Infants born at <35 weeks GA

Data Source: Data from Medicaid claims for pregnancy linked to birth certificates for women covered by Medicaid in Arkansas

Sample Size: Total (n= 5,150) 2001 (n= 812) 2002 (n= 1,105) 2003 (n= 824) 2004 (n= 824) 2005 (n= 887) 2006 (n= 698) Infants born at <35 weeks GA

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Access to Provider through Hotline HOSPITAL Continuing Education of Hospital Providers POPULATION-BASED SYSTEMS INTER-HOSPITAL SYSTEMS Maternal/In-Utero Transport Systems Consultation Systems (Inter-Hospital Systems) Consultation Systems (Hospital) Telemedicine Systems (Inter-Hospital Systems) Telemedicine Systems (Hospital) STATE Policy/Guideline (State)

Intervention Description: Telemedicine has been used successfully for medical care and education but it has never been utilized to modify patterns of delivery in an established state network.

Intervention Results: Medicaid deliveries at the regional perinatal centers increased from 23.8% before the intervention to 33% in neonates between 500 and 999 grams (p<0.05) and was unchanged in neonates between 2001-2500 grams.

Conclusion: Telemedicine is an effective way to translate evidence based medicine into clinical care when combined with a general educational conference. Patterns of deliveries appear to be changing so that those newborns at highest risk are being referred to the regional perinatal centers.

Study Design: Time trend analysis

Setting: All Arkansas hospitals

Population of Focus: Infants born weighing 500-2499 gm. Data not given for other study years.

Data Source: Data from Arkansas Vital Statistics Data System linked with corresponding hospitalization records from Arkansas Hospital Discharge Data System.

Sample Size: Total (n= 12,258) 2001 (n= 2,965) 2004 (n= 3,154)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Transition Assistance PATIENT/CONSUMER HOSPITAL Continuing Education of Hospital Providers POPULATION-BASED SYSTEMS INTER-HOSPITAL SYSTEMS Neonatal Back-Transport Systems Consultation Systems (Inter-Hospital Systems) Consultation Systems (Hospital) Telemedicine Systems (Inter-Hospital Systems) Telemedicine Systems (Hospital)

Intervention Description: Assessed a telemedicine (TM) network's effects on decreasing deliveries of very low birth weight (VLBW, <1500 g) neonates in hospitals without Neonatal Intensive Care Units (NICUs) and statewide infant mortality.

Intervention Results: Deliveries of VLBW neonates in targeted hospitals decreased from 13.1 to 7.0% (P=0.0099); deliveries of VLBW neonates in remaining hospitals were unchanged. Mortality decreased in targeted hospitals (13.0% before TM and 6.7% after TM). Statewide infant mortality decreased from 8.5 to 7.0 per 1000 deliveries (P=0.043).

Conclusion: TM decreased deliveries of VLBW neonates in hospitals without NICUs and was associated with decreased statewide infant mortality.

Study Design: QE: pretest-posttest

Setting: All Arkansas hospitals (Nine selected as telemedicine hospitals due to high patient volume)

Population of Focus: Infants born weighing <1500 gm

Data Source: Medicaid data for VLBW infants as indicated by ICD-9 diagnosis codes from hospital and physician claims for pregnancy. Data infant with birth and infant death certificates.

Sample Size: Pretest (n= 383) Posttest (n= 384)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination Telemedicine Systems (Inter-Hospital Systems) Quality Improvement Targeting Interventions to Focused Groups

Intervention Description: N/A

Intervention Results: Those with No USC and Facility USCs increased 10 and 18 percent, respectively, while those with Person USCs decreased by 43 percent. Compared to those in the lowest income bracket, those in the highest income bracket were less likely to have a Facility USC. Among those with low incomes, individuals with No USC, Person, in Facility, and Facility USCs were more likely to have ED visits than those with Person USCs.

Conclusion: A growing number are reporting facilities as their USCs or none at all. The impact of these trends is uncertain, although we found that some USC types are associated with ED visits and hospital admissions. Tracking USCs will be crucial to measuring progress toward enhanced care efficiency.

Study Design: We stratified each USC category, by age, region, gender, poverty, insurance, race/ethnicity, and education and used regression to determine the characteristics associated with USC types, ED visits, and hospital admissions.

Setting: 1996-2014 Medical Expenditure Panel Surveys

Population of Focus: Low income individuals, those with no USC

Sample Size: 559762

Age Range: All ages, five categories

Intervention Components (click on component to see a list of all articles that use that intervention): Telemedicine Systems (Inter-Hospital Systems)

Intervention Description: N/A

Conclusion: 1. Telerehabilitation is a promising approach for children and youth with developmental disabilities, and can be more effective than face-to-face treatment or no treatment in improving outcomes. 2. Telerehabilitation interventions that target both the caregiver and the child, with clinicians actively involved and caregivers actively participating in treatment sessions, are more likely to be successful. 3. Family-centered care is beneficial for children and families when providing care, and addressing the needs of both the caregiver and the child is important. 4. Telerehabilitation interventions targeting improvement of parent-related outcomes are lacking. 5. Videoconference is the most commonly used platform for telerehabilitation interventions. 6. Certain professional disciplines, such as speech-language pathology, are more likely to publish studies on tele-assessment practices. 7. Blended models of care, where traditional face-to-face services are appropriately complemented by telehealth, could enhance healthcare delivery, access, and client-centeredness.

Study Design: Systematic Review