ASR ANALYTICS, LLCEvaluation Study: Social & Economic Impact of BTOP Grant

Curtis Lowery, MDBTOP Grant Principal InvestigatorProfessor & Chair, Department of Obstetrics & Gynecology

ANGELS Medical Director

8:15 – 9:45 a.m.

October 22, 2013

Existing UAMS Telemedicine Programs Enhanced by BTOP

• ANGELS (Antenatal & Neonatal Guidelines & Education System)• Evidence-based guidelines• Education and support for OB providers via teleconferences• Consultation Call Center available 24/7• Case Management• Expansion of telemedicine network & clinics

• Tele-Nursery• Tele-Colposcopy• Prison obstetrics

• Evaluation and research

• AR SAVES (Stroke Assistance through Virtual Emergency Support)• Links rural ER doctors to specially trained vascular neurologists via live, two-

way video, available 24-hours a day

A national award winning telehealth program that serves as a model for other programs is the first of its kind to link three state agencies to serve a common purpose in statewide management of high-risk obstetrical patients, targeting the impoverished, the unhealthy & those at risk of having premature & low-birth-weight babies.

ANGELSAntenatal & Neonatal Guidelines & Education System

“Where you live should not be a barrier to excellent health or education !” Curtis Lowery, M.D.

“Technologies exist today that can prevent distance from imposing a barrier to the delivery of quality education and excellent healthcare, and it is a

shame that we have failed to used them!” Curtis Lowery, M.D.

The ANGELS mission is to ensure that every woman in Arkansas at risk of having a complicated pregnancy receives the best possible perinatal care.

The ANGELS mission is to ensure that every woman in Arkansas at risk of having a complicated pregnancy receives the best possible perinatal care.

ANGELS Telehealth Sites

2009

2013

• ANGELS Telemedicine Sites – total of 30• Telemedicine visits• Telemedicine OB ultrasound visits• Fetal echocardiogram visits

• Tele-Nursery Sites – total of 25• Census rounds three times each week• Provides follow-up on transferred patients, video connection with a

postpartum mother at a delivery facility to her baby at Arkansas Children’s Hospital

• Consults by neonatologists or other pediatric sub-specialists• Discuss co-management of patients to facilitate back-transfer

• Tele-Colposcopy Telemedicine Sites – total of 8• Colposcopy exams that help identify women with high-grade lesions

requiring treatment * ANGELS Annual Report - 2012

ANGELSAntenatal & Neonatal Guidelines & Education System

• Education and support for OB providers is offered through teleconferences• High-Risk Obstetrics Case Conference• OB/GYN Grand Rounds• FAIM (Fetal Anomaly Interdisciplinary Management)• ONE Team (Obstetric & Neonatal Nurse Education)• Peds PLACE (Pediatric Physician Learning and

Cooperative Education)

• A total of 268 continuing education hours were earned in 2012 by health care providers that attended these video conferences.

* ANGELS Annual Report - 2012

ANGELSAntenatal & Neonatal Guidelines & Education System

The ANGELS model of telemedicine care has the distinction of being studied for replication across other disciplines and agencies to connect infrastructures within health care, higher education, research, and public safety across a single, unified network.

ANGELSAntenatal & Neonatal Guidelines & Education System

ANGELS Consultations 2009-2012

2009

2010

2011

2012

0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000

Yea

r BTOP Grant Awarded August 2010

• AR SAVES links ER doctors to specially trained vascular neurologists via live, two-way video, available 24-hours a day.

• Participating hospitals are equipped with telemedicine technology, training for personnel, support for dedicated tele-stroke coordinator and ongoing education.

• Many rural hospitals, without the support of a neurologist, often forgo administration of a clot busting drug, tissue plasminogen activator (tPA).

• The window of time needed to effectively administer tPA is often lost when stroke patients are transported to a better-equipped, remote hospital miles from their home.

• AR SAVES increases access to subspecialty expertise through telemedicine technology, providing a coordinated assessment and care-based plan for Arkansas’ stroke patients.

(Stroke Assistance through Virtual Emergency Support)

• In 2012, Arkansas was the #1 state in the nation for per capita stroke deaths.

• From November 2008 - June 2013, 24% of more than 1,700 consults resulted in 417 patients being treated with tPA.

• This has saved health care dollars and decreased mortality and disability from stroke.

• AR SAVES currently has three hub and 40 spoke sites across Arkansas.

* AR SAVES Annual Report - 2013

(Stroke Assistance through Virtual Emergency Support)

ARKANSAS

ASHLEY

BAXTERBENTON BOONE

BRADLEY

CALHOUN

CARROLL

CHICOT

CLARK

CLAY

CLEBURNE

CLEVELAND

COLUMBIA

CONWAY

CRAIGHEAD

CRAWFORD

CRITTENDEN

CROSS

DALLAS

DESHA

DREW

FAULKNER

FRANKLIN

FULTON

GARLAND

GRANT

GREENE

HEMPSTEAD

HOT SPRING

HOWARD

INDEPENDENCE

IZARD

JACKSON

JEFFERSON

JOHNSON

LAFAYETTE

LAWRENCE

LEE

LINCOLN

LITTLE RIVER

LOGAN

LONOKE

MADISON

MARION

MILLER

MISSISSIPPI

MONROE

MONTGOMERY

NEVADA

NEWTON

OUACHITA

PERRY

PHILLIPS

PIKE

POINSETT

POLK

POPE

PRAIRIE

PULASKI

RANDOLPH

ST. FRANCIS

SALINE

SCOTT

SEARCY

SEVIER

SHARP

STONE

UNION

VAN BUREN

WASHINGTON

WHITE

WOODRUFF

YELLHub Site

HybridHub Site

1 – 4 Consults

5 – 9 Consults

10 + Consults

No Consults

Total t-PA Delivery - FY 2013

ARKANSAS

ASHLEY

BAXTERBENTON BOONE

BRADLEY

CALHOUN

CARROLL

CHICOT

CLARK

CLAY

CLEBURNE

CLEVELAND

COLUMBIA

CONWAY

CRAIGHEAD

CRAWFORD

CRITTENDEN

CROSS

DALLAS

DESHA

DREW

FAULKNER

FRANKLIN

FULTON

GARLAND

GRANT

GREENE

HEMPSTEAD

HOT SPRING

HOWARD

INDEPENDENCE

IZARD

JACKSON

JEFFERSON

JOHNSON

LAFAYETTE

LAWRENCE

LEE

LINCOLN

LITTLE RIVER

LOGAN

LONOKE

MADISON

MARION

MILLER

MISSISSIPPI

MONROE

MONTGOMERY

NEVADA

NEWTON

OUACHITA

PERRY

PHILLIPS

PIKE

POINSETT

POLK

POPE

PRAIRIE

PULASKI

RANDOLPH

ST. FRANCIS

SALINE

SCOTT

SEARCY

SEVIER

SHARP

STONE

UNION

VAN BUREN

WASHINGTON

WHITE

WOODRUFF

YELLHub Site

HybridHub Site

1 – 4 Consults

5 – 9 Consults

10 + Consults

No Consults

Total Consults - FY 2013

* AR SAVES Annual Report - 2013

2009 2010 2011 20120

100

200

300

400

500

600

700

Consultst-PASites

* AR SAVES Annual Report - 2013

ANGELS Evolution

2002 2006 2008

Federal Communications Commission

Rural Health Care Pilot Program

Tele-Nursery

2007 2010

In 2012, there were 4,403 OB patient visits completed, many of them high-risk OB referrals from AR providers.

FY 2013, there were 594 stroke consults with 151 patients receiving tPA. Stroke

Assistance through Virtual Emergency Support

2011

Adult Sickle Cell Clinical Program

Guideline Smartphone Application

Postpartum Hypertension Project

2013

UAMS/CDH HIV TM Clinic