An Overview of Distribution of Births in United States Hospitals in 2008 with Implications for Small Volume Perinatal Units in Rural Hospitals

Simpson, Kathleen Rice

doi:10.1111/j.1552-6909.2011.01262.x

Cited by 53 publications

(53 citation statements)

References 9 publications

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“…1,2 Rural-urban differences in obstetric care are important for financial and policy reasons, as well clinical and public health reasons. Small absolute differences in childbirth care can affect the health of thousands of women and infants every year, with such differences growing ever-larger if they are driven by disparate trends.…”

Section: Introductionmentioning

confidence: 99%

Rural-Urban Differences in Obstetric Care, 2002–2010, and Implications for the Future

Kozhimannil¹,

Hung²,

Prasad³

et al. 2014

Medical Care

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Background Approximately 15% of the 4 million annual U.S. births occur in rural hospitals. Objective To 1) measure differences in obstetric care in rural and urban hospitals and 2) examine whether trends over time differ by rural-urban hospital location Research Design and Subjects Retrospective analysis of hospital discharge records for all births in the 2002-2010 Nationwide Inpatient Sample, a 20% sample of U.S. hospitals (N=7,188,972 births; 6,316,743 in urban hospitals, 837,772 in rural hospitals). Measures Rates of low-risk cesarean (full-term, singleton, vertex pregnancies; no prior cesarean), vaginal birth after cesarean (VBAC), non-indicated cesarean, and non-indicated labor induction. Results In 2010, low-risk cesarean rates in rural and urban hospitals were 15.5% and 16.1%, respectively, and non-indicated cesarean rates were 16.9% and 17.8%. VBAC rates were 5.0% in rural and 10.0% in urban hospitals in 2010. Between 2002 and 2010, rates of low-risk cesarean and non-indicated cesarean increased, and VBAC rates decreased in both rural and urban hospitals. Non-indicated labor induction was less frequent in rural versus urban hospitals in 2002 (AOR=0.79 [0.78-0.81]), but increased more rapidly in rural hospitals from 2002-2010 (AOR=1.05 [1.05-1.06]). In 2010, 16.5% of rural births were induced without indication (12.0% of urban births). Conclusions From 2002-2010, cesarean rates rose and VBAC rates fell in both rural and urban hospitals. Non-indicated labor induction rates rose disproportionately faster in rural vs. urban settings. Tailored clinical and policy tools are needed to address differences between rural and urban hospitals.

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Section: Introductionmentioning

confidence: 99%

Rural-Urban Differences in Obstetric Care, 2002–2010, and Implications for the Future

Kozhimannil¹,

Hung²,

Prasad³

et al. 2014

Medical Care

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“…Most US births occur in community hospitals where labour care is managed by nurses under physician or midwife supervision. Nurses in these settings have considerable autonomy in providing support, surveillance and moment-to-moment management of labour,11 12 and registered nurses have a similar role in Canada and some other countries. To date, nurse-sensitive measures for the labour nurse context are lacking.…”

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confidence: 99%

Thematic analysis of US stakeholder views on the influence of labour nurses’ care on birth outcomes

2017

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Background Childbirth is a leading reason for hospital admission in the USA, and most labour care is provided by registered nurses under physician or midwife supervision in a nurse-managed care model. Yet, there are no validated nurse-sensitive quality measures for maternity care. We aimed to engage primary stakeholders of maternity care in identifying the aspects of nursing care during labour and birth they believe influence birth outcomes, and how these aspects of care might be measured. Methods This qualitative study used 15 focus groups to explore perceptions of 73 nurses, 23 new mothers and 9 physicians regarding important aspects of care. Transcripts were analysed thematically. Participants in the final six focus groups were also asked whether or not they thought each of five existing perinatal quality measures were nurse-sensitive. Results Nurses, new mothers and physicians identified nurses' support of and advocacy for women as important to birth outcomes. Support and advocacy actions included keeping women and their family members informed, being present with women, setting the emotional tone, knowing and advocating for women's wishes and avoiding caesarean birth. Mothers and nurses took technical aspects of care for granted, whereas physicians discussed this more explicitly, noting that nurses were their 'eyes and ears' during labour. Participants endorsed caesarean rates and breastfeeding rates as likely to be nurse-sensitive.Conclusions Stakeholder values support inclusion of maternity nursing care quality measures related to emotional support and providing information in addition to physical support and clinical aspects of care. Care models that ensure labour nurses have sufficient time and resources to engage in the supportive relationships that women value might contribute to better health outcomes and improved patient experience.

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“…Approximately 70% of U.S. hospitals that offer obstetric services have fewer than 1,400 births per hospital. 11 As such, identification of cases needs to be efficient and simple, regardless of whether the methods of ascertainment use information that is already extant or derived from a new system of data collection. Finally, because identification of cases and estimation of frequencies by themselves are insufficient to denote quality (or lack thereof), the definition needs to provide for opportunities to improve quality based on insights obtained on review of care.…”

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confidence: 99%

Facility-Based Identification of Women With Severe Maternal Morbidity

Callaghan

Grobman

Kilpatrick³

et al. 2014

Obstetrics &Amp; Gynecology

119

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Although maternal deaths have been the traditional indicator of maternal health, these events are the “tip of the iceberg” in that there are many women who have significant complications of pregnancy, labor, and delivery. Identifying women who experience severe maternal morbidity and reviewing their care can provide critical information to inform quality improvement in obstetrics. In this commentary, we review methods to identify women who experienced severe complications of pregnancy. We propose a simple validated approach based on transfusion of four or more units of blood products, admission to an intensive care unit, or both as a starting point for identification and review of severe maternal morbidity in health care settings for the purpose of understanding successes and failures in systems of care.

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An Overview of Distribution of Births in United States Hospitals in 2008 with Implications for Small Volume Perinatal Units in Rural Hospitals

Cited by 53 publications

References 9 publications

Rural-Urban Differences in Obstetric Care, 2002–2010, and Implications for the Future

Rural-Urban Differences in Obstetric Care, 2002–2010, and Implications for the Future

Thematic analysis of US stakeholder views on the influence of labour nurses’ care on birth outcomes

Facility-Based Identification of Women With Severe Maternal Morbidity

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