Changing patterns in regionalization of perinatal care and the impact on neonatal mortality,☆☆,

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Abstract

OBJECTIVE: Our goal was to study changing patterns of low-birth-weight outcome over the past decade as deregionalized perinatal care has occurred. STUDY DESIGN: Live births and neonatal mortality for two 5-year periods (1982 to 1986 vs 1990 to 1994) were calculated by hospital of delivery in the state of Missouri. Self-designated level of perinatal care was contrasted with number of deliveries and nursery census to evaluate outcome. Regression models were constructed to compare outcome between levels of care. RESULTS: There has been a significant shift of deliveries into self-designated level II and III perinatal centers. However, this is largely a result of redesignation of care rather than an actual increase in acuity or census. The relative risk of neonatal mortality for very-low-birth-weight infants is 2.28 in level II centers compared with level III centers, and is unchanged (2.57) from 10 years earlier. Nearly 14% of very-low-birth-weight deliveries still occur at non–level III centers. CONCLUSION: Changing patterns of perinatal regionalization have not improved outcome for inborn infants <1500 gm except in level III centers. Attempts should be made to deliver very-low-birth-weight infants in level III centers. (Am J Obstet Gynecol 1998;178:131-5.)

Section snippets

Material and methods

Using linked birth and death certificates, we examined Missouri resident live births occurring in Missouri's hospitals for two time periods: 1982 to 1986 and 1990 to 1994. Live-born infants with birth weights of <500 gm were excluded from examination. Live births with birth defects having a ≥50% probability of death within the neonatal period, as defined by the Missouri Multi-Source Birth Defect Registry, were also excluded. Diagnoses within these categories included anencephaly, renal agenesis

Results

During the initial 5-year time period (1982 to 1986), 381,866 deliveries occurred in 120 obstetric units that were eligible for study, with 887 deliveries excluded from analysis. During the latter time period (1990 to 1994), 390,741 eligible deliveries occurred in 98 obstetric units, with 1018 deliveries excluded. The comparison of the two time periods demonstrates a significant change in location of deliveries, as defined by level of care. As shown in Fig. 1, 90 of 120 (75.0%) hospitals with

Comment

Many factors have altered the delivery of health care in this decade. Perinatal care is merely one component of the total health care package, but many analysts consider it an important component. Providing obstetric care improves the profile of the hospital and may generate a more attractive package to the payor market. Further, adding levels of enhanced acuity may seem to further improve the attractiveness, not only to the payor but also to the public.

LeFevre et al.15 have shown that term and

References (18)

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From the The Perinatal Center, Saint Luke's Hospital of Kansas City, and the Department of Obstetrics and Gynecology, University of Missouri–Kansas City School of Medicine, and the Center for Health Information Management and Epidemiology, Missouri Department of Health.

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Reprint requests: John D. Yeast, MD, The Perinatal Center, Saint Luke's Hospital of Kansas City, Forty-fourth and Wornall Road, Kansas City, MO 64111.

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