Planning the optimal level of local maternity service for small rural communities: A systems study in British Columbia

Grzybowski, Stefan; Kornelsen, Jude; Schuurman, Nadine

doi:10.1016/j.healthpol.2009.03.007

Cited by 42 publications

(65 citation statements)

References 18 publications

(25 reference statements)

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“…6 The RBI provides an objective assessment of community need for local maternity services based on a mathematical model that relates the size of the local birthing population with the degree of social vulnerability of the population and the level of geographic isolation of the community in a score that reflects an optimal and sustainable local maternity service level.…”

Section: Participants Methods and Resultsmentioning

confidence: 99%

Rural Birth Index for Australia?

Kildea

Stratigos

2010

Australian J Rural Health

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Canada and Australia face similar challenges in delivering maternity care to small rural communities. The closure of many small maternity units for similar reasons -workforce shortages, lack of on-site caesarean section facilities, safety concerns and centralisation policies -have been reported in both countries over the last decade. [1][2][3][4][5] This has usually occurred with scant community consultation, little evidence-based policy, and in both countries it has resulted in increasing distress in rural communities.

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Section: Participants Methods and Resultsmentioning

confidence: 99%

Rural Birth Index for Australia?

Kildea

Stratigos

2010

Australian J Rural Health

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“…A higher value indicates the need for a more specialized level of care, ranging from 0-7 (maternity service level A: no local intrapartum services) and 7-9 (service level B: local intrapartum services without operative delivery) to greater than 27 (service level E: specialist only models). 20 The percentage of women delivering at their local hospital was calculated as the number of women delivering at their community hospital divided by the total number of deliveries to women residing in that community.…”

Section: Statistical Analysesmentioning

confidence: 99%

Safety of labour and delivery following closures of obstetric services in small community hospitals

Hutcheon

Riddell

Strumpf

et al. 2016

CMAJ

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The safety of obstetric services in small, rural communities remains uncertain. Delivery at hospitals with low delivery volumes has been correlated with better, worse and comparable pregnancy outcomes compared with delivery at larger centres, [1][2][3][4][5][6][7] and studies examining the safety of delivery at rural versus urban hospitals have likewise produced conflicting results. [8][9][10][11][12] Establishing the relative safety of obstetric care in small rural hospitals is challenging. Studies comparing health outcomes according to hospital delivery volume 3-5 are influenced by underlying referral patterns in which higher rates of adverse outcomes at larger centres may reflect referrals of high-risk women. Adjustment for maternal risk factors is unlikely to completely account for case-mix differences. Comparisons made according to catchment area (in which women are classified according to their place of residence) 1,2,4,[8][9][10][11][12] prevent bias due to referral patterns, but confounding by differences in socioeconomic status and health behaviours between women living in urban and rural areas remains a concern.10 Such comparisons also have less utility for decisions about service regionalization because the policy option is not to change rural women's place of residence to an urban setting, but rather to have rural women travel to an urban setting to deliver, which may lead to increased risks, such as unintentional out-of-hospital delivery. Since 1998, nearly one-third of hospitals in British Columbia, Canada, have stopped providing planned obstetric services. The vast majority of service closures occurred in low-volume hospitals (< 150 deliveries/yr) serving smaller, rural communities. In this study, we examined whether the frequency and severity of maternal-neonatal labour and delivery health outcomes of women residing in small communities were affected by the closure of their community hospitals. Other implications of obstetric service provision in small communities (e.g., social, economic), although important, are beyond the scope of this study. In recent decades, many smaller hospitals in British Columbia, Canada, have stopped providing planned obstetric services. We examined the effect of these service closures on the labour and delivery outcomes of pregnant women living in affected communities.

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“…Its Rural Birth Index is a composite score measuring the level of need for local intrapartum maternity services (CRHR n.d.). The score is then parameterized against an optimal level of service that should be sustainable (Grzybowski et al 2009). Service strata based on index strata can be created and population outcomes compared temporally at the hospital catchment level or across the service strata level (Grzybowski et al 2011).…”

Section: Mcbride Prince Georgementioning

confidence: 99%

Rural Health Services: Finding the Light at the End of the Tunnel

Grzybowski

Kornelsen²

2013

hcpol

Self Cite

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Many rural communities across Canada are facing challenges to the sustainability of core emergency and acute care health services, primarily due to problems with medical and nursing staffing. Data related to service efficacy and effectiveness are not well organized. Most of Canada still relies on reporting by large geopolitical areas (local health areas) that do not always relate natural catchment population outcomes to community hospital services. Re-organizing rural health services' outcome reporting by the characteristics of geographically defined catchment populations would facilitate better planning, systemic quality improvement and stronger continuing professional development for health professionals. It may also serve to inform the transformation of core health services in larger communities. RésuméPlusieurs communautés rurales au Canada font face à des défis en termes de durabilité des services essentiels de santé d'urgence et des soins de courte durée, principalement en raison de problèmes de personnel médical et infirmer. Les données sur l' efficacité et l' efficience des services ne sont pas bien organisées. Dans la majeure partie du Canada, le traitement des données est encore lié à de grandes régions géopolitiques (circonscriptions sanitaires), ce qui ne permet pas toujours d' associer les résultats d'un bassin naturel de population aux services hospitaliers communautaires. En réorganisant la production de résultats dans les services de santé ruraux selon les caractéristiques des bassins de population définis géographiquement, il serait plus facile de procéder à la planification, à l' amélioration de la qualité du système et à un meilleur perfectionnement professionnel continu pour le personnel. Cela pourrait aussi permettre d' éclairer la réorganisation des services de santé essentiels dans les plus grandes communautés.

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Planning the optimal level of local maternity service for small rural communities: A systems study in British Columbia

Cited by 42 publications

References 18 publications

Rural Birth Index for Australia?

Rural Birth Index for Australia?

Safety of labour and delivery following closures of obstetric services in small community hospitals

Rural Health Services: Finding the Light at the End of the Tunnel

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