Lessons For Providers And Hospitals From Philadelphia’s Obstetric Services Closures And Consolidations, 1997–2012

Lorch, Scott A.; Martin, Ashley E.; Ranade, Richa; Srinivas, Sindhu K.; Grande, David

doi:10.1377/hlthaff.2014.0136

Cited by 13 publications

(5 citation statements)

References 22 publications

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“…Recruitment concluded once thematic saturation was reached. 26,27 Design Study participants were approached in the NICU within 2 weeks of the infant's anticipated discharge. After enrollment, participants completed demographics and the Parent Health Literacy Activities Test, an 8-item validated measure of health literacy and numeracy developed for families of infants.…”

Section: Participantsmentioning

confidence: 99%

Perspectives of Low Socioeconomic Status Mothers of Premature Infants

et al. 2017

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BACKGROUND AND OBJECTIVES: Transitioning premature infants from the NICU to home is a highrisk period with potential for compromised care. Parental stress is high, and families of low socioeconomic status may face additional challenges. Home visiting programs have been used to help this transition, with mixed success. We sought to understand the experiences of at-risk families during this transition to inform interventions.

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Section: Participantsmentioning

confidence: 99%

Perspectives of Low Socioeconomic Status Mothers of Premature Infants

et al. 2017

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“…[22][23][24] Zhang and colleagues 24 found that the closures were associated with a substantial increase in neonatal birth injuries, with increases most pronounced among mothers living in communities with closures. Allen and colleagues 25 compared time trends of iatrogenic preterm delivery, fetal growth restriction and perinatal mortality in regions of Nova Scotia, Canada, Note: CI = confidence interval, IQR = interquartile range.…”

Section: Discussionmentioning

confidence: 99%

Safety of labour and delivery following closures of obstetric services in small community hospitals

Hutcheon

Riddell

Strumpf

et al. 2016

CMAJ

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The safety of obstetric services in small, rural communities remains uncertain. Delivery at hospitals with low delivery volumes has been correlated with better, worse and comparable pregnancy outcomes compared with delivery at larger centres, [1][2][3][4][5][6][7] and studies examining the safety of delivery at rural versus urban hospitals have likewise produced conflicting results. [8][9][10][11][12] Establishing the relative safety of obstetric care in small rural hospitals is challenging. Studies comparing health outcomes according to hospital delivery volume 3-5 are influenced by underlying referral patterns in which higher rates of adverse outcomes at larger centres may reflect referrals of high-risk women. Adjustment for maternal risk factors is unlikely to completely account for case-mix differences. Comparisons made according to catchment area (in which women are classified according to their place of residence) 1,2,4,[8][9][10][11][12] prevent bias due to referral patterns, but confounding by differences in socioeconomic status and health behaviours between women living in urban and rural areas remains a concern.10 Such comparisons also have less utility for decisions about service regionalization because the policy option is not to change rural women's place of residence to an urban setting, but rather to have rural women travel to an urban setting to deliver, which may lead to increased risks, such as unintentional out-of-hospital delivery. Since 1998, nearly one-third of hospitals in British Columbia, Canada, have stopped providing planned obstetric services. The vast majority of service closures occurred in low-volume hospitals (< 150 deliveries/yr) serving smaller, rural communities. In this study, we examined whether the frequency and severity of maternal-neonatal labour and delivery health outcomes of women residing in small communities were affected by the closure of their community hospitals. Other implications of obstetric service provision in small communities (e.g., social, economic), although important, are beyond the scope of this study. In recent decades, many smaller hospitals in British Columbia, Canada, have stopped providing planned obstetric services. We examined the effect of these service closures on the labour and delivery outcomes of pregnant women living in affected communities.

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“…In 2017, a typical SVB admission costs $15 000, compared to a cesarean admission, which cost $11 200 8,9 . These costs may be a particular concern for Medicaid which pays for 43% of the births in the United States, 10 as well as for hospitals that find that labor and delivery are a “money‐losing” service 11,12 . There is also the cost of interventions that do not improve outcomes and might decrease the chance of an SVB, such as continuous fetal heart monitoring 13 .…”

Section: Introductionmentioning

confidence: 99%

Spontaneous vaginal birth varies significantly across US hospitals

Clark

Lake

2020

Birth

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Background Birth is the most common reason for hospitalization in the United States. Hospital variation in maternal outcomes is an important indicator of health care quality. Spontaneous vaginal birth (SVB) is the most optimal birth outcome for the majority of mothers and newborns. The purpose of this study was to examine hospital‐level variation in SVB overall and among low‐risk women in a four‐state sample representing 25% of births in the United States in 2016. Methods Women giving birth in California, Pennsylvania, New Jersey, and Florida were identified in 2016 state discharge abstracts. Patient data were merged with hospital data from the American Hospital Association's (AHA) 2016 Annual Survey. Overall and low‐risk SVB rates were calculated for each hospital in the sample and stratified by bed size, teaching status, rurality, birth volume, and state. Results Our final sample included 869 681 women who gave birth in 494 hospitals. The mean overall SVB rate in the sample was 61.1%, ranging from 16.8% to 79.9%. The mean low‐risk SVB rate was 78% and ranged from 34.6% to 93.3%. Variation in SVB rates cut across all the hospital structural characteristic strata. Discussion The wide variation in SVB rates indicates significant room for improvement in this maternal quality metric. Our finding, that hospitals of all types and locations had both low and high SVB rates, suggests that excellent maternal outcomes are possible in all hospital settings. The variation in SVB rates across hospitals warrants research into modifiable hospital factors that may be influencing SVB rates.

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Lessons For Providers And Hospitals From Philadelphia’s Obstetric Services Closures And Consolidations, 1997–2012

Cited by 13 publications

References 22 publications

Perspectives of Low Socioeconomic Status Mothers of Premature Infants

Perspectives of Low Socioeconomic Status Mothers of Premature Infants

Safety of labour and delivery following closures of obstetric services in small community hospitals

Spontaneous vaginal birth varies significantly across US hospitals

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