Rural Hospital Administrators’ Beliefs About Safety, Financial Viability, and Community Need for Offering Obstetric Care

Kozhimannil, Katy B.; Interrante, Julia D.; Admon, Lindsay K.; Ibrahim, Bridget Basile

doi:10.1001/jamahealthforum.2022.0204

Cited by 15 publications

(25 citation statements)

References 39 publications

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“…Responding hospitals had a median of 274 births in 2019 (IQR 120–446) and a median average daily census of 22 (IQR 10–53). The sample is described in full detail elsewhere [ 63 , 75 ].…”

Section: Resultsmentioning

confidence: 99%

“…Study methods have been described in detail elsewhere [ 63 ]. In brief, we identified rural hospitals that were operating an inpatient labor and birth in 2018 based on an enhanced two-stage method [ 64 ].…”

Section: Methodsmentioning

confidence: 99%

“…A 47-question web-based survey was developed with expertise from rural clinicians and administrators and piloted with administrators at six rural hospitals [ 63 ]. Questions were edited for clarity after pilot review.…”

Section: Methodsmentioning

confidence: 99%

“…The ongoing COVID-19 pandemic impacted hospital administrator availability to participate in research and may also have influenced responses. Responding and non-responding hospitals were not significantly dissimilar, other than responding hospitals being more likely to be located in the West and less likely to be located in the South [ 63 ]. A strength of this study is that it is among the first to collect data about availability of evidence-based maternal and infant health resources from rural communities themselves, and it presents new information on social vulnerability and social determinants of maternal and infant health in rural US counties.…”

Section: Limitationsmentioning

confidence: 99%

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Inequities in Availability of Evidence-Based Birth Supports to Improve Perinatal Health for Socially Vulnerable Rural Residents

et al. 2022

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Rural residents in the United States (US) have disproportionately high rates of maternal and infant mortality. Rural residents who are Black, Indigenous, and People of Color (BIPOC) face multiple social risk factors and have some of the worst maternal and infant health outcomes in the U.S. The purpose of this study was to determine the rural availability of evidence-based supports and services that promote maternal and infant health. We developed and conducted a national survey of a sample of rural hospitals. We determined for each responding hospital the county-level scores on the 2018 CDC Social Vulnerability Index (SVI). The sample’s (n = 93) median SVI score [IQR] was 0.55 [0.25–0.88]; for majority-BIPOC counties (n = 29) the median SVI score was 0.93 [0.88–0.98] compared with 0.38 [0.19–0.64] for majority-White counties (n = 64). Among counties where responding hospitals were located, 86.2% located in majority-BIPOC counties ranked in the most socially vulnerable quartile of counties nationally (SVI ≥ 0.75), compared with 14.1% of majority-White counties. In analyses adjusted for geography and hospital size, certified lactation support (aOR 0.36, 95% CI 0.13–0.97), midwifery care (aOR 0.35, 95% CI 0.12–0.99), doula support (aOR 0.30, 95% CI 0.11–0.84), postpartum support groups (aOR 0.25, 95% CI 0.09–0.68), and childbirth education classes (aOR 0.08, 95% CI 0.01–0.69) were significantly less available in the most vulnerable counties compared with less vulnerable counties. Residents in the most socially vulnerable rural counties, many of whom are BIPOC and thus at higher risk for poor birth outcomes, are significantly less likely to have access to evidence-based supports for maternal and infant health.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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Inequities in Availability of Evidence-Based Birth Supports to Improve Perinatal Health for Socially Vulnerable Rural Residents

et al. 2022

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“…Their results showed 28% of rural hospitals without OB units had births in their ED; of these, 32% had unanticipated adverse birth outcomes, 22% experienced a delay in urgent transport, and 80% reported a need for additional training and/or resources for emergencies, which included neonatal resuscitation, precipitous childbirth, and management of serious complications such as postpartum hemorrhage. 7 The Iowa Statewide Obstetric Mobile Simulation Program used traditional components of competency as a structure for the program. The three components include knowledge, skills, and attitudes.…”

Section: Program Design and Planningmentioning

confidence: 99%

Obstetrical Readiness: Preparing Rural Emergency Departments Without Hospital-Based Obstetrical Services

FORMAN¹,

HENKLE

2022

Clinical Obstetrics &Amp; Gynecology

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In rural states, hospitals that provide birthing services are closing at an alarming rate, increasing the distance birthing people are traveling, rural Emergency Departments play a vital role in reducing maternal morbidity and mortality. An interdisciplinary education and simulation with debriefing program was created to improve the care by non-obstetric providers for routine and emergent obstetrical care. The program includes monthly lectures, hands on skills training, and in-situ interdisciplinary simulations with debriefings to build a foundation of knowledge and skill for rural Emergency Department staff statewide.

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Obstetric Volume and Severe Maternal Morbidity Among Low-Risk and Higher-Risk Patients Giving Birth at Rural and Urban US Hospitals

et al. 2023

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ImportanceIdentifying hospital factors associated with severe maternal morbidity (SMM) is essential to clinical and policy efforts.ObjectiveTo assess associations between obstetric volume and SMM in rural and urban hospitals and examine whether these associations differ for low-risk and higher-risk patients.Design, Setting, and ParticipantsThis retrospective cross-sectional study of linked vital statistics and patient discharge data was conducted from 2022 to 2023. Live births and stillbirths (≥20 weeks’ gestation) at hospitals in California (2004-2018), Michigan (2004-2020), Pennsylvania (2004-2014), and South Carolina (2004-2020) were included. Data were analyzed from December 2022 to May 2023.ExposuresAnnual birth volume categories (low, medium, medium-high, and high) for hospitals in urban (10-500, 501-1000, 1001-2000, and &gt;2000) and rural (10-110, 111-240, 241-460, and &gt;460) counties.Main Outcome and MeasuresThe main outcome was SMM (excluding blood transfusion); covariates included age, payer status, educational attainment, race and ethnicity, and obstetric comorbidities. Analyses were stratified for low-risk and higher-risk obstetric patients based on presence of at least 1 clinical comorbidity.ResultsAmong more than 11 million urban births and 519 953 rural births, rates of SMM ranged from 0.73% to 0.50% across urban hospital volume categories (high to low) and from 0.47% to 0.70% across rural hospital volume categories (high to low). Risk of SMM was elevated for patients who gave birth at rural hospitals with annual birth volume of 10 to 110 (adjusted risk ratio [ARR], 1.65; 95% CI, 1.14-2.39), 111 to 240 (ARR, 1.37; 95% CI, 1.10-1.70), and 241 to 460 (ARR, 1.26; 95% CI, 1.05-1.51), compared with rural hospitals with greater than 460 births. Increased risk of SMM occurred for low-risk and higher-risk obstetric patients who delivered at rural hospitals with lower birth volumes, with low-risk rural patients having notable discrepancies in SMM risk between low (ARR, 2.32; 95% CI, 1.32-4.07), medium (ARR, 1.66; 95% CI, 1.20-2.28), and medium-high (ARR, 1.68; 95% CI, 1.29-2.18) volume hospitals compared with high volume (&gt;460 births) rural hospitals. Among hospitals in urban counties, there was no significant association between birth volume and SMM for low-risk or higher-risk obstetric patients.Conclusions and RelevanceIn this cross-sectional study of births in US rural and urban counties, risk of SMM was elevated for low-risk and higher-risk obstetric patients who gave birth in lower-volume hospitals in rural counties, compared with similar patients who gave birth at rural hospitals with greater than 460 annual births. These findings imply a need for tailored quality improvement strategies for lower volume hospitals in rural communities.

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Rural Hospital Administrators’ Beliefs About Safety, Financial Viability, and Community Need for Offering Obstetric Care

Cited by 15 publications

References 39 publications

Inequities in Availability of Evidence-Based Birth Supports to Improve Perinatal Health for Socially Vulnerable Rural Residents

Inequities in Availability of Evidence-Based Birth Supports to Improve Perinatal Health for Socially Vulnerable Rural Residents

Obstetrical Readiness: Preparing Rural Emergency Departments Without Hospital-Based Obstetrical Services

Obstetric Volume and Severe Maternal Morbidity Among Low-Risk and Higher-Risk Patients Giving Birth at Rural and Urban US Hospitals

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