Hospital Factors and Nontransfer of Small Babies: A Marker of Deregionalized Perinatal Care?

Abstract

OBJECTIVES:Our purpose was to examine the contribution of hospital factors (e.g., reimbursement sources, teaching status) to the rate of nontransfer of <1250 g infants born in nontertiary hospitals in Illinois. We chose nontransfer as a marker of the extent to which there have been structural changes in the regionalized perinatal care system in Illinois. STUDY DESIGN:Using data from live birth certificates (1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996), from the American Hospital Association's Annual Survey of Hospitals (1990Hospitals ( to 1996, and Illinois hospital discharge records (1992 to 1996), we simultaneously assessed the effect of hospital and individual factors on nontransfer of infants <1250 g (n ¼ 2904). RESULTS:When adjusted for individual risk factors, several hospital factors were associated with nontransfer. These include birth in a Level II þ hospital (odds ratios(OR) 3.75; 95% CI 2.29, 5.29), high Medicaid revenues (OR 1.97; 95% CI 1.58, 2.47), high HMO revenues (OR 1.39; 95% CI 1.11, 2.28), and status as a teaching hospital (OR 1.63; 95% CI 1.30, 2.09). CONCLUSIONS:This study suggests that there should be careful consideration of the role of hospital factors in perinatal deregionalization in order to preserve the improvements in maternal and infant outcomes associated with regionalized perinatal care.

Risk factors for not delivering in a level III unit before 32 weeks of gestation: results from a population‐based study in Paris and surrounding districts in 2003

“…In the only French study on this question, babies cared for in level IIB units had higher mortality regardless of gestational age 34 . A better understanding of the health consequences of these decisions and the factors which may make it possible to provide optimal care for high‐risk babies outside tertiary units is necessary as there is a growing trend in many countries towards a deregionalisation of perinatal care out of large tertiary centres 35,36 …”

Changes in care and outcome of very preterm babies in the Parisian region between 1998 and 2003

“…Regionalisation was implemented in the late 1990s in France and some other countries of Europe and, in 2004, regionalised neonatal networks were established in the UK 11–14. In the USA deregionalisation during the 1990s kept this issue on the research and policy agenda 15 16…”

Effect of Opening Midlevel Neonatal Intensive Care Units on the Location of Low Birth Weight Births in California

“…12,24,25 Although a range of factors such as insurance status, maternal education, and obstetric risk factors can influence the choice of hospital for birth, increased availability of, and easier access to, midlevel units in some areas may have led to increased use. [26][27][28][29][30][31] The literature on the effects of NICU availability on use of different levels of care is sparse. Although recent studies have shown that more low birth weight (LBW) infants are being born and cared for at midlevel unit hospitals, none have specifically addressed how the entrance of a new midlevel NICU into an area affects where LBW infants are born in that area.…”