TY - JOUR
T1 - Associations Between Hospital Maternal Service Level and Delivery Outcomes
AU - Vanderlaan, Jennifer
AU - Rochat, Roger
AU - Williams, Bryan
AU - Dunlop, Anne
AU - Shapiro, Susan E.
N1 - Funding Information:
Supported by grant number R36HS024655 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. Supported by grant number R36HS024655 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. The authors gratefully acknowledge Gordon Freymann, MPH, and David Austin, MPH, Office of Health Indicators for Planning (OHIP), Georgia Department of Public Health, for advising on the linkage and providing data for this study; and Michael Kramer, PhD, and Jennifer Davis Runkle, PhD, for linking vital records and hospital discharge data across all years of the study and for support in calculating severe maternal morbidity. Supported by grant number R36HS024655 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.
Publisher Copyright:
© 2019 Jacobs Institute of Women's Health
PY - 2019/5/1
Y1 - 2019/5/1
N2 - Objective: This study explored the associations between delivery hospital self-reported level of maternal service, as defined by the American Hospital Association, and both maternal and neonatal outcomes among women at high maternal risk, as defined by the Obstetric Comorbidity Index. Methods: This was a secondary analysis of linked delivery hospitalization discharge and vital records data for women experiencing singleton births in Georgia from 2008 to 2012. The need for maternal transfer was defined using a sample-specific cut-off of the risk score calculated using the Obstetric Comorbidity Index. Outcomes included poor maternal outcome (severe maternal morbidity or death), maternal length of stay, preterm delivery, low birth weight, and perinatal death. The analysis was completed using hierarchical logistic regression with a two-level model considering hospital level of maternal service and controlling for maternal race and transfer status. Results: In these data, there was no difference in the odds of a poor maternal or neonatal outcome according to delivery hospital level of maternal care; however, delivery at a hospital with maternal service level III was associated with a higher odds of an extended length of stay. Conclusions: For this group of pregnant women in need of maternal transfer, delivery hospital self-reported level of maternal care was not associated with the odds of poor maternal or neonatal outcomes. This study supports the need for improved definitions of hospital level of maternal services.
AB - Objective: This study explored the associations between delivery hospital self-reported level of maternal service, as defined by the American Hospital Association, and both maternal and neonatal outcomes among women at high maternal risk, as defined by the Obstetric Comorbidity Index. Methods: This was a secondary analysis of linked delivery hospitalization discharge and vital records data for women experiencing singleton births in Georgia from 2008 to 2012. The need for maternal transfer was defined using a sample-specific cut-off of the risk score calculated using the Obstetric Comorbidity Index. Outcomes included poor maternal outcome (severe maternal morbidity or death), maternal length of stay, preterm delivery, low birth weight, and perinatal death. The analysis was completed using hierarchical logistic regression with a two-level model considering hospital level of maternal service and controlling for maternal race and transfer status. Results: In these data, there was no difference in the odds of a poor maternal or neonatal outcome according to delivery hospital level of maternal care; however, delivery at a hospital with maternal service level III was associated with a higher odds of an extended length of stay. Conclusions: For this group of pregnant women in need of maternal transfer, delivery hospital self-reported level of maternal care was not associated with the odds of poor maternal or neonatal outcomes. This study supports the need for improved definitions of hospital level of maternal services.
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U2 - 10.1016/j.whi.2019.02.004
DO - 10.1016/j.whi.2019.02.004
M3 - Article
C2 - 30935820
AN - SCOPUS:85063438503
VL - 29
SP - 252
EP - 258
JO - Women's Health Issues
JF - Women's Health Issues
SN - 1049-3867
IS - 3
ER -