Optimal maternal and neonatal outcomes and associated hospital characteristics

Abstract

Background: This study aims to examine hospital variation in both maternal and neonatal morbidities and identify institutional characteristics associated with hospital performance in a combined measure of maternal and neonatal outcomes. Methods: Using the California Linked Birth File containing data from birth certificate and hospital discharge records, we identified 1 322 713 term births delivered at 248 hospitals during 2010-2012. For each hospital, a risk-standardized rate of severe maternal morbidities and a risk-standardized rate of severe newborn morbidities were calculated after adjusting for patient clinical risk factors. Hospitals were ranked based on combined information on their maternal and newborn morbidity rates. Results: Risk-standardized severe maternal and severe newborn morbidity rates varied substantially across hospitals (10th to 90th percentile range = 67.5-148.2 and 141.8-508.0 per 10 000 term births, respectively), although there was no significant association between the two (P = 0.15). Government hospitals (non-Federal) were more likely than other hospitals to be in worse rank quartiles (P value for trend = 0.004), whereas larger volume was associated with better rank among hospitals in the first three quartiles (P = 0.004). The most prevalent morbidities that differed progressively across hospital rank quartiles were severe hemorrhage, disseminated intravascular coagulation, and heart failure during procedure/surgery for mothers, and severe infection, respiratory complication, and shock/resuscitation for neonates. Conclusions: Hospitals with low maternal morbidity rates may not have low neonatal morbidity rates and vice versa, highlighting the importance of assessing joint maternal-newborn outcomes in order to fully characterize a hospital's obstetrical performance. Hospitals with smaller volume and government ownership tend to have less desirable outcomes and warrant additional attention in future quality improvement efforts. K E Y W O R D Schildbirth, hospital variation, morbidity, obstetric, quality and safety 290 | CAMPBELL Et AL.

Birth Volume and Geographic Distribution of US Hospitals With Obstetric Services From 2010 to 2018

“…Regionalization research has historically focused on infants at high risk, including preterm infants (Յ37 weeks' gestation) or those with very low birth weight (<1500 g). 14,[41][42][43][44][45] Available studies of term infants or those with a birth weight greater than 2500 g suggest that infants born in hospitals with lower birth volumes are at greater risk for adverse outcomes, [9][10][11][12] although associations in rural hospitals have varied with regard to volume. 17 The assessment of obstetric hospital proximity revealed the number of isolated obstetric hospitals, most of which were low volume and at elevated risk of closure.…”

“…Overall, 18.9% of low-volume obstetric hospitals were considered isolated, and of these, 58.4% were located in rural areas. Given the importance of access to obstetric services and data supporting an association between volume and outcome in neonatal care, these findings may be particularly informative when approaches to improve perinatal care delivery and associated policies are being considered.…”

“…Annual obstetric hospital volume, defined as the number of births per year, is an active area of perinatal research given the positive associations between volume and outcome reported in other medical disciplines. [6][7][8] In perinatal care, delivery at higher-volume obstetric hospitals is associated with improved infant [9][10][11][12][13] and maternal 5 outcomes among low-risk term infants and in high-risk populations, such as infants with very low birth weight. [14][15][16] However, among rural hospitals, associations between the quality of obstetric care (eg, cesarean delivery without indication, labor induction without indication, and episiotomy) and volume have varied.…”

Measuring Childbirth Outcomes Using Administrative and Birth Certificate Data

“…In this study, we found that hospital rates of maternal complications were poorly correlated with hospital rates of newborn complications, a finding also recently reported by another group of investigators. 44 We found that 13% of hospitals ranked as high-performance outliers based on newborn outcomes were low-performance outliers based Fig. 3.…”

The causal effect of delivery volume on severe maternal morbidity: an instrumental variable analysis in Sichuan, China

“…In the obstetric field, scholars have conducted several studies to investigate the relationship between delivery volume and maternal health outcomes, which, however, provided mixed findings. While some studies indicated that delivery volume is positively correlated with maternal health outcomes,11–15 other studies reported the absence of a statistically significant correlation between them 16–19…”