The effectiveness of regionalization of perinatal care services - a systematic review

Rashidian, Arash; Omidvari, Amir Houshang; Vali, Yasaman; Mortaz, Seyed; Yousefi‐Nooraie, Reza; Jafari, Mahdi; Bhutta, Zulfiqar Ahmed

doi:10.1016/j.puhe.2014.08.005

Cited by 59 publications

(63 citation statements)

References 68 publications

(62 reference statements)

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“…Moreover, before-after studies of the impact of regionalization programs on neonatal outcomes fall prey to confounding by secular trends, inadvertently reflecting concurrent changes in the field. 9 Network analysis elucidates how the flow of patients changes over time, clarifying the impact of regionalization itself, regardless of other changes. Having a method to quantify neonatal care at a systems level represents a more rigorous and complete approach to assessing regionalization.…”

Section: Discussionmentioning

confidence: 99%

“…9 Regionalization involves a linking of hospitals in a coordinated system of communication, learning and response. Over the past several decades, these networks have been shaped by regulatory policy, financial incentives, and market forces.…”

Section: Introductionmentioning

confidence: 99%

“…Previous attempts to assess the effect of regionalization on outcomes have been limited by their reliance on hospital-level characteristics or before-after study designs, rather than an understanding of the flow of patients through a care delivery system. 3,6,7,9,12,19,20 Accounting for the characteristics of the patients and their movement through the care delivery network would provide for a more granular understanding of the way care networks function for infants requiring acute transport.…”

Section: Introductionmentioning

confidence: 99%

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Network analysis: a novel method for mapping neonatal acute transport patterns in California

et al. 2017

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Objective To use network analysis to describe the pattern of neonatal transfers in California, to compare empirical sub-networks with established referral regions, and to determine factors associated with transport outside the originating sub-network. Study Design This cross-sectional database study included 6546 infants <28 days old transported within California in 2012. After generating a graph representing acute transfers between hospitals (n=6696), we used community detection techniques to identify more tightly connected sub-networks. These empirically-derived sub-networks were compared to state-defined regional referral networks. Reasons for transfer between empirical sub-networks were assessed using logistic regression. Results Empirical sub-networks showed significant overlap with regulatory regions (p <0.001). Transfer outside the empirical sub-network was associated with major congenital anomalies (p<0.001), need for surgery (p=0.01), and insurance as the reason for transfer (p<0.001). Conclusion Network analysis accurately reflected empirical neonatal transfer patterns, potentially facilitating quantitative, rather than qualitative, analysis of regionalized health care delivery systems.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Network analysis: a novel method for mapping neonatal acute transport patterns in California

et al. 2017

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“…40 Antenatal transfers lead to better neonatal survival when compared with postnatal transfers, 41,42 decreases in short and long-term disabilities and costs, 43–46 and increased bonding between a mother and her critically ill newborn. 43 However, the evidence for the specific advances gained with perinatal regionalization is not as well-defined for obstetric care.…”

Section: Discussionmentioning

confidence: 99%

United States and territory policies supporting maternal and neonatal transfer: review of transport and reimbursement

Okoroh

Kroelinger

Lasswell³

et al. 2015

J Perinatol

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OBJECTIVE Summarize policies that support maternal and neonatal transport among states and territories. STUDY DESIGN Systematic review of publicly available, web-based information on maternal and neonatal transport for each state and territory in 2014. Information was abstracted from published rules, statutes, regulations, planning documents and program descriptions. Abstracted information was summarized within two categories: transport and reimbursement. RESULTS Sixty-eight percent of states and 25% of territories had a policy for neonatal transport; 60% of states and one territory had a policy for maternal transport. Sixty-two percent of states had a reimbursement policy for neonatal transport, whereas 20% reimbursed for maternal transport. Thirty-two percent of states had an infant back-transport policy while 16% included back-transport for both. No territories had reimbursement or back-transport policies. CONCLUSION The lack of development of maternal transport reimbursement and neonatal back-transport policies negatively impacts the achievements of risk-appropriate care, a strategy focused on improving perinatal outcomes.

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“…Despite these successes, current rates of decline in maternal, neonatal, and under-five mortality rates will not reach the global targets of a three-quarter reduction in maternal mortality and a two-thirds reduction in under-five child mortality by 2015 [4]. Furthermore, inequalities in access to health services widen the gap in mortality rates between the rich and poor in low-income countries (LICs), which account for 99% of global maternal deaths [5]; the MMR is reported to be14-times higher in LICs than developed countries [4]. Specifically, sub-Saharan Africa has 510 maternal deaths per 100,000 live births and South Asiahas190 maternal deaths per 100,000 live births [6–8].…”

Section: Introductionmentioning

confidence: 99%

A Controlled Before-and-After Perspective on the Improving Maternal, Neonatal, and Child Survival Program in Rural Bangladesh: An Impact Analysis

et al. 2016

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ObjectivesWe evaluated the impact of the Improving Maternal, Neonatal, and Child Survival (IMNCS) project, which is being implemented by BRAC in rural communities in Bangladesh.MethodsFour districts received program intervention i.e. trained community health workers to deliver essential maternal, neonatal, and child healthcare and nutrition services while two districts were treated as comparison group. A quasi-experimental study design (compared before-and-after) was undertaken. Baseline survey was conducted in 2008 among 7200 women followed by end line in 2012 among 4800 women with similar characteristics in the same villages. We evaluated maternal antenatal and post natal checkup, birth plans and delivery, complication and referred cases during antenatal checkup and post natal period, and child health indicators such as birth asphyxia, neonatal sepsis, and its management by the medically trained provider.FindingsIncreased number (four or more) antenatal visits, skill-birth attended delivery and postnatal visits (three or more) in the intervention group preceding four-year intervention period were observed compare to their counterpart. We noted negative difference-in-difference estimator (-5.0%, P = 0.159) regarding to the all major birth plans i.e. delivery place, birth attendant, and saved money in the comparison areas. Significant reduction of ante-partum and intra-partum complications occurred in the intervention group, contrary complications of such event increased in the comparison areas (-6.3%, P<0.05 and -20.5%, P<0.001 respectively). Referral case to the health centers due to these complications boosted significantly in intervention group than comparison group (2.3%, P<0.01 and 6.6%, P<0.001 respectively). Mother’s knowledge of breastfeeding initiation and the practice of initiating breastfeeding within an hour of birth amplified significantly (14.6%, P<0.001 and 8.3%, P<0.001 respectively). We did not find any significant difference regards to the management of low birth weight by the medically trained health care provider and complete vaccination between the intervention and comparison arm.ConclusionMedically trained health care provider assisted community based public health intervention could increase number of antenatal and postnatal visit, thereby could decrease pregnancy associated complications. These interventions may be considered for further up scaling when resources are limited.

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The effectiveness of regionalization of perinatal care services - a systematic review

Cited by 59 publications

References 68 publications

Network analysis: a novel method for mapping neonatal acute transport patterns in California

Network analysis: a novel method for mapping neonatal acute transport patterns in California

United States and territory policies supporting maternal and neonatal transfer: review of transport and reimbursement

A Controlled Before-and-After Perspective on the Improving Maternal, Neonatal, and Child Survival Program in Rural Bangladesh: An Impact Analysis

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