The association between hospital obstetric volume and perinatal outcomes in California

Snowden, Jonathan M.; Cheng, Yvonne W.; Kontgis, Caitlin; Caughey, Aaron B.

doi:10.1016/j.ajog.2012.09.029

Cited by 56 publications

(50 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…9,20,34 Additionally, prior research indicating greater risk of maternal morbidity (such as postpartum hemorrhage) and postpartum complications in low-volume rural settings may influence clinical recommendations or personal decisions regarding delivery location. 35–37 Indeed, our findings show higher rates of non-local childbirth among rural women whose local hospital has 460 births or fewer each year (Table 3). Future research on personal and clinical decision-making around delivery location may elucidate both medical and non-medical reasons for these patterns.…”

Section: Commentmentioning

confidence: 61%

Location of childbirth for rural women: implications for maternal levels of care

Kozhimannil

Casey

Hung

et al. 2016

American Journal of Obstetrics and Gynecology

View full text Add to dashboard Cite

BACKGROUND A recent American College of Obstetricians and Gynecologists and Society for Maternal Fetal Medicine consensus statement on levels of maternity care lays out designations that correspond to specific capacities available in facilities that provide obstetric care. Pregnant women in rural and remote areas receive particular attention in discussions of regionalization and levels of care, owing to the challenges in assuring local access to high-acuity services when necessary. Currently, approximately half a million rural women give birth each year in US hospitals, and whether and which of these women give birth locally is crucial for successfully operationalizing maternal levels of care. OBJECTIVES To characterize rural women who give birth in non-local hospitals and measure local hospital characteristics and maternal diagnoses present at childbirth that are associated with non-local childbirth. STUDY DESIGN This was a repeat cross-sectional analysis of administrative hospital discharge data for all births to rural women in nine states in 2010 and 2012. Multivariate logistic regression models were used to predict the odds of childbirth in a non-local hospital (at least 30 road miles from the patient's residence). We examined patient age, race/ethnicity, payer, rurality, clinical diagnoses (diabetes, hypertension, hemorrhage during pregnancy, placental abnormalities, malpresentation, multiple gestation, preterm delivery, prior cesarean delivery, and a composite of diagnoses that may require maternal-fetal medicine consultation), as well as local hospital characteristics (birth volume, neonatal care level, ownership, accreditation, and system affiliation). RESULTS The rate of non-local childbirth among 216,076 rural women was 25.4%. It varied significantly by primary payer (Adjusted Odds Ratio [95% Confidence Interval]=0.76 [0.68,0.86]) for Medicaid vs. private insurance) and by clinical conditions including multiple gestation (1.82 [1.58,2.1]), preterm deliveries (2.41 [2.17,2.67]), and conditions which may require maternal fetal medicine services or consultation (1.28 [1.22,1.35]). Rural women whose local hospital did not have a neonatal intensive or intermediate care unit had nearly double the odds of giving birth at a non-local hospital (1.94 [1.64,2.31]). CONCLUSION Approximately 75% of rural women gave birth at local hospitals; rural women with preterm births and clinical complications, as well as those without local access to higher-acuity neonatal care, were more likely to give birth in non-local hospitals. However, after controlling for clinical complications, rural Medicaid beneficiaries were less likely to give birth at non-local hospitals, implying a potential access challenge for this population.

show abstract

Section: Commentmentioning

confidence: 61%

Location of childbirth for rural women: implications for maternal levels of care

Kozhimannil

Casey

Hung

et al. 2016

American Journal of Obstetrics and Gynecology

View full text Add to dashboard Cite

show abstract

“…Hospitals were designated as rural based on California Office of Statewide Health Planning and Development classification or if they were located in a town with a California Association of Rural Health Clinics member clinic or in a rural zip code. 14 Data on whether a hospital had midwifery and 24-hour in-house obstetric coverage were obtained from telephone surveys of labor and delivery staff conducted in 2011 and 2012. Patient-level variables obtained from neonate birth and maternal discharge records included maternal age, race or ethnicity, education status (classified as less than or greater than a completed high school diploma), and insurance (public or private insurance); whether labor was induced; gestational age at delivery; and neonate’s birth weight.…”

Section: Methodsmentioning

confidence: 99%

Association Between Vaginal Birth After Cesarean Delivery and Primary Cesarean Delivery Rates

Rosenstein

Kuppermann

Gregorich

et al. 2013

Obstetrics &Amp; Gynecology

Self Cite

View full text Add to dashboard Cite

OBJECTIVE To estimate the association between vaginal birth after cesarean delivery (VBAC) rates and primary cesarean delivery rates in California hospitals. METHODS Hospital VBAC rates were calculated using birth certificate and discharge data from 2009, and hospitals were categorized by quartile of VBAC rate. Multivariable logistic regression analysis was performed to estimate the odds of cesarean delivery among low-risk nulliparous women with singleton pregnancies at term in vertex presentation (nulliparous term singleton vertex) by hospital VBAC quartile while controlling for many patient-level and hospital-level confounders. RESULTS There were 468,789 term singleton births in California in 2009 at 255 hospitals, 125,471 of which were low-risk nulliparous term singleton vertex. Vaginal birth after cesarean delivery rates varied between hospitals, with a range of 0–44.6%. Rates of cesarean delivery among low-risk nulliparous term singleton vertex women declined significantly with increasing VBAC rate. When adjusted for maternal and hospital characteristics, low-risk nulliparous term singleton vertex women who gave birth in hospitals in the highest VBAC quartile had an odds ratio of 0.55 (95% confidence interval 0.46–0.66) of cesarean delivery compared with women at hospitals with the lowest VBAC rates. Each percentage point increase in a hospital’s VBAC rate was associated with a 0.65% decrease in the low-risk nulliparous term singleton vertex cesarean delivery rate. CONCLUSION Hospitals with higher rates of VBAC have lower rates of primary cesarean delivery among low-risk nulliparous women with singleton pregnancies at term in vertex presentation.

show abstract

“…36 The association is less clear for outcomes of lower risk infants. 37,38 Few studies have investigated how hospital characteristics affect severe maternal morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…36 The association is less clear for outcomes of lower risk infants. 37,38 Few studies have investigated how hospital characteristics affect severe maternal morbidity.Our analysis has limitations. We used administrative (ICD-9 procedure and diagnosis codes) and birth certificate data rather than medical chart review for our analysis.…”

mentioning

confidence: 99%

Association Between Hospital-level Obstetric Quality Indicators and Maternal and Neonatal Morbidity

Howell

Zeitlin

Hebert

et al. 2015

Obstetric Anesthesia Digest

View full text Add to dashboard Cite

Importance-In an effort to improve the quality of care, several obstetric-specific quality measures are now monitored and publically reported. The extent to which these measures are associated with maternal and neonatal morbidity is not known.Objective-To examine whether 2 Joint Commission obstetric quality indicators are associated with maternal and neonatal morbidity.Design, Setting, and Participants-Population-based observational study using linked 2010 New York City discharge and birth certificate datasets. All delivery hospitalizations were identified and two perinatal quality measures were calculated. Published algorithms were used to identify severe maternal morbidity (delivery associated with a life threatening complication or performance of a life-saving procedure) and morbidity in non-anomalous term newborns (births The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.Author Contributions: Dr. Egorova had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.• Study concept and design: Howell, Zeitlin, Hebert, Balbierz, and Egorova associated with complications such as birth trauma, hypoxia, and prolonged length of stay). Mixed-effects logistic regression models were used to examine the association between maternal morbidity, neonatal morbidity, and hospital-level quality measures while risk-adjusting for patient sociodemographic and clinical characteristics. Exposure-TwoJoint Commission perinatal quality measures: 1) elective (non-medically indicated) deliveries at >= 37 and < 39 weeks of gestation and 2) cesarean delivery performed in low-risk mothers.Main Outcomes and Measures-Individual and hospital level maternal and neonatal morbidity. Although great progress has been made in reducing obstetric complications, they persist. Severe maternal complications include renal failure and eclampsia or the need for lifesaving interventions such as prolonged mechanical ventilation or transfusions. 1,2 Neonatal complications may occur in low-risk term infants and include hypoxia and shock. 3 Severe maternal morbidity occurs in about 60,000 women (1.6 per 100 deliveries) annually in the US and 1 in 10 term infants experience neonatal complications. 3,4 Variation in complication rates between hospitals exists and suggests that the quality of obstetric care can be improved. 5 Over a third of maternal deaths and severe morbidities, and a significant proportion of neonatal mortality and morbidity may be preventable by changes in patient, clinician, and system factors. 4,[6][7][8][9] As part of its core measure set, the Joint Commission now recommends two perinatal quality measures that address important aspects of obstetric care during childbirth: 1) elective deliveries performed prior to 39 weeks of gestation and 2) cesarean deliveries performed in low-risk nulliparous women. 10 The elective delivery measure, which includes non-medi...

show abstract

The association between hospital obstetric volume and perinatal outcomes in California

Cited by 56 publications

References 23 publications

Location of childbirth for rural women: implications for maternal levels of care

Location of childbirth for rural women: implications for maternal levels of care

Association Between Vaginal Birth After Cesarean Delivery and Primary Cesarean Delivery Rates

Association Between Hospital-level Obstetric Quality Indicators and Maternal and Neonatal Morbidity

Contact Info

Product

Resources

About