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  • Original Article
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Hospital Factors and Nontransfer of Small Babies: A Marker of Deregionalized Perinatal Care?

Abstract

OBJECTIVES: Our purpose was to examine the contribution of hospital factors (e.g., reimbursement sources, teaching status) to the rate of nontransfer of <1250 g infants born in nontertiary hospitals in Illinois. We chose nontransfer as a marker of the extent to which there have been structural changes in the regionalized perinatal care system in Illinois.

STUDY DESIGN: Using data from live birth certificates (1989–1996), from the American Hospital Association's Annual Survey of Hospitals (1990 to 1996), and Illinois hospital discharge records (1992 to 1996), we simultaneously assessed the effect of hospital and individual factors on nontransfer of infants <1250 g (n=2904).

RESULTS: When adjusted for individual risk factors, several hospital factors were associated with nontransfer. These include birth in a Level II+hospital (odds ratios(OR) 3.75; 95% CI 2.29, 5.29), high Medicaid revenues (OR 1.97; 95% CI 1.58, 2.47), high HMO revenues (OR 1.39; 95% CI 1.11, 2.28), and status as a teaching hospital (OR 1.63; 95% CI 1.30, 2.09).

CONCLUSIONS: This study suggests that there should be careful consideration of the role of hospital factors in perinatal deregionalization in order to preserve the improvements in maternal and infant outcomes associated with regionalized perinatal care.

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References

  1. MacDorman M, Rowley D, Iyasu S, et al., editors. Infant Mortality In: From Data to Action. Washington, DC; US Department of Health and Human Services, Public Health Service, and Centers for Disease Control, National Center for Health Statistics; 1994. p. 231–249.

  2. Paneth N . The problem of low birth weight. In: Behrman RE, editor. The Future of Children—Low Birth Weight. Vol 5, No 1. Los Altos, CA: Center for the Future of Children, The David and Lucile Packard Foundation; 1995. p. 19–34.

    Google Scholar 

  3. McCormick M, Richardson D . Access to neonatal intensive care. In: Behrman RE, editor. The Future of Children—Low Birth Weight. Vol 5, No 1. Los Altos, CA: Center for the Future of Children, The David Lucile Packard Foundation; 1995. p. 162–175.

    Google Scholar 

  4. Carmichael S, Iyasu S, Hatfield-Timajchy K . Cause-specific trends in neonatal mortality among black and white infants, United States, 1980–1995. Maternal Child Health J 1998;2(2):67–76.

    Article  CAS  Google Scholar 

  5. March of Dimes Birth Defects Foundation. Towards Improving the Outcome of Pregnancy. White Plains, NY: March of Dimes Birth Defects Foundation; 1993.

  6. Paneth N, Kiely J, Wallenstein S, et al. Newborn intensive care and neonatal mortality in low-birth weight infants. N Engl J Med 1982;307(3):149–155.

    Article  CAS  Google Scholar 

  7. Ozminkiwski R, Wortman P, Roloff D, et al. Inborn/outborn status and neonatal survival: a meta-analysis of non-randomized studies. Stat Med 1988;7:1207–1221.

    Article  Google Scholar 

  8. Kollee L, Verloove-Vanhorick S, Verwey R, et al. Maternal and neonatal transport: results of a national collaborative survey of preterm very low birthweight infants in the Netherlands. Obstet Gynecol 1988;72(5):729–732.

    CAS  PubMed  Google Scholar 

  9. Kollee L, Brand R, Schrevder A, et al. Five-year outcome of preterm and very low birth weight infants: a comparison between maternal and neonatal transport. Obstet Gynecol 1992;80:635–638.

    CAS  PubMed  Google Scholar 

  10. Mayfield J, Rosenblatt R, Baldwin L, et al. The relation of obstetrical volume and nursery level to perinatal mortality. Am J Public Health 1990;80(7):819–823.

    Article  CAS  Google Scholar 

  11. Powell S, Holt V, Hickok O, et al. Recent changes in delivery site of low-birth-weight infants in Washington: impact on birth weight-specific mortality. Am J Obstet Gynecol 1995;173(5):1585–1592.

    Article  CAS  Google Scholar 

  12. Phibbs C, Bronstein J, Buxton E, et al. The effects of patient volume and level of care at the hospital of birth on neonatal mortality. J Am Med Assoc 1996;276:1054–1059.

    Article  CAS  Google Scholar 

  13. Menard M, Liu Q, Holgren E, et al. Neonatal mortality for very low birth weight deliveries in South Carolina by level of hospital perinatal service. Am J Obstet Gynecol 1998;179:374–381.

    Article  CAS  Google Scholar 

  14. Gagnon D, Allison-Cooke S, Schwartz R . Perinatal care: the threat of deregionalization. Pediatr Ann 1988;17:447–452.

    Article  CAS  Google Scholar 

  15. Johnson K, Little G . State health agencies and quality improvement in perinatal care. Pediatrics 1999;103(1 Suppl E):233–247.

    CAS  PubMed  Google Scholar 

  16. Howell E, Richardson D, Ginsburg P, et al. Deregionalization of neonatal intensive care in urban areas. Am J Public Health 2002;92(1):119–124.

    Article  Google Scholar 

  17. Mehta S, Atherton H, Schoettker P, et al. Differential markers for regionalization. J Perinatol 2000;20:366–372.

    Article  CAS  Google Scholar 

  18. Yeast J, Poskin M, Stockbauer J, Shaffer S . Changing patterns in regionalization of perinatal care and the impact on neonatal mortality. Am J Obstet Gynecol 1998;178(1):131–135.

    Article  CAS  Google Scholar 

  19. Illinois Department of Public Health. Prevention of Developmental Disability Act and Regionalized Perinatal Code 1990. Illinois Department of Public Health: Springfield, IL, 1990.

  20. Kotelchuck M . An evaluation of the Kessner Adequacy of Prenatal Care Index and a Proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health 1994;84:1414–1420.

    Article  CAS  Google Scholar 

  21. Cifuentes J, Bronstein J, Phibbs C, et al. Mortality in low birth weight infants according to level of neonatal care of birth. Pediatrics 2002;109(5):745–751.

    Article  Google Scholar 

  22. Samuelson J, Buehler J, Norris D, Sadek R . Maternal characteristics associated with place of delivery and neonatal mortality rates among very low birth weight infants, Georgia. Paediatr Perinat Epidemiol 2002;16:305–313.

    Article  Google Scholar 

  23. Dooley S, Freels S, Turnock B . Quality assessment of perinatal regionalization by multivariate analysis: Illinois 1991–1993. Obstetr Gynecol 1997;89(2):193–198.

    Article  CAS  Google Scholar 

  24. Schwartz R . Supply and demand for neonatal intensive care: trends and implications. J Perinatol 1996;16(6):483–489.

    CAS  PubMed  Google Scholar 

  25. Hein H . Regionalization of perinatal health care: a lesson learned but lost. J Perinatol 1999;19(8):584–588.

    Article  CAS  Google Scholar 

  26. Gerber S, Dobez D, Budetti P . (2001) Managed care and perinatal regionalization in Washington State. Obstetr Gynecol 2001;98(1):139–143.

    CAS  Google Scholar 

  27. Durbin D, Giardino A, Shaw K, et al. The effect of insurance status on likelihood of neonatal interhospital transfer. Pediatrics 1997;100(3):e8.

    Article  CAS  Google Scholar 

  28. Glied S, Gnanasekaran S . Hospital financing and neonatal intensive care. Health Services Res 1996;31(5):593–607.

    CAS  Google Scholar 

  29. Bottoms S, Paul R, Mercer B, et al. Obstetric determinants of neonatal survival: antenatal predictors of neonatal survival and morbidity in extremely low birth weight infants. Am J Obstetr Gynecol 1999;180(3):665–669.

    Article  CAS  Google Scholar 

  30. Meadow W, Kim M, Mendez D, et al. Which nurseries currently care for ventilated neonates in Illinois and Wisconsin? Implications for the next generation of perinatal regionalization. Am J Perinatol 2002;19:197–203.

    Article  Google Scholar 

  31. Illinois Department of Public Health. Title 77: Public Health Chapter 1: Department of Public Health, Subchapter 1: Maternal and Childcare. Part 640, Regionalized Perinatal Health Care Code. Springfield, IL, August, 2000.

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Acknowledgements

This work was carried out with support from the March of Dimes.

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Wall, S., Handler, A. & Park, C. Hospital Factors and Nontransfer of Small Babies: A Marker of Deregionalized Perinatal Care?. J Perinatol 24, 351–359 (2004). https://doi.org/10.1038/sj.jp.7211101

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