Impact of Rural Hospital Closures on Patient Outcomes in a Perinatal Region of Georgia [4E]

Abstract

INTRODUCTION: Rural hospital closures in the United States have left millions without access to healthcare. <50% of rural counties have hospital-based obstetrical services. Despite this, there are limited studies on the impact of obstetrical unit closures on patient outcomes. Augusta University Medical Center (AUMC) is the designated tertiary center for one of Georgia's six perinatal regions. We hypothesized that rural hospital closures directly impacted the outcomes of our patients. METHODS: The National Institute of Health's I2B2 software was used to identify charts of patients seen at AUMC for obstetrical services between January 1, 2010-December 31, 2011 and January 1, 2015-December 31, 2016. A retrospective chart review was performed to obtain and compare clinical outcomes between cohorts. RESULTS: 6,096 charts were reviewed. 58.6% (3572/6096) of charts met inclusion criteria representing 74.6% (1501/2012) and 71.2% (2071/2910) of actual deliveries at AUMC for 2010-11 and 2015-16, respectively. Evaluated parameters included: obesity, birthweight, prematurity, APGARs, length of stay, insurance, psychiatric disease, hypertension, NICU admission, neonatal death, ICU admission, readmission, tobacco/substance use, cardiopulmonary disease, diabetes, VTE, transfusion/return to operating room. There we statistically significant increases in PTD and low APGARs/birth weight for those >76 miles away. Statistically significant decreases in normal birthweight infants for those >76 miles away. There were increased rates of substance abuse for all zip codes in 2015-16. There were no statistically significant differences in obesity, hypertension, neonatal death, ICU admissions, readmissions, VTE, or transfusions/return to the OR. CONCLUSION: Hospital closures within our perinatal region directly impacted aspects of patient outcomes at AUMC.