PDF icon PDF herunterladen
Am J Perinatol 2019; 36(06): 653-658
DOI: 10.1055/s-0038-1672140
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Do Hospitals with a Higher Level of Maternal Care Designation Have Better Maternal Outcomes?

Sindhu K. Srinivas
1   Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania, Philadelphia, Pennsylvania
,
Katy Kozhimannil
2   Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
,
Peiyin Hung
3   Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
,
Laura Attanasio
4   Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, Massachusetts
,
Judy Jou
5   WORLD Policy Analysis Center, University of California – Los Angeles, Los Angeles, California
,
William A. Grobman
6   Department of Obstetrics and Gynecology, Northwestern Feinberg School of Medicine, Chicago, Illinois
› Institutsangaben
Weitere Informationen

Publikationsverlauf

25. Mai 2018

14. August 2018

Publikationsdatum:
18. Oktober 2018 (online)

Auch verfügbar aufeRefHebammen
   Lizenzen und Reprints
Preview

Abstract

Background A recent document by the American Congress of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine introduced the concept of uniform levels of maternal care (LMCs).

Objective We assessed LMC across hospitals and measured their association with maternal morbidity, focusing on women with high-risk conditions.

Study Design We collected data from hospitals from May to November 2015 and linked survey responses to Statewide Inpatient Databases (SID) hospital discharge data in a retrospective cross-sectional study of 247,383 births admitted to 236 hospitals. Generalized logistic regression models were used to examine the associations between hospitals' LMC and the risk of severe maternal morbidity. Stratified analyses were conducted among women with high-risk conditions.

Results High-risk pregnancies were more likely to be managed in hospitals with higher LMC (p < 0.001). Women with cardiac conditions had lower odds of maternal morbidity when delivered in level I compared with level IV units (adjusted odds ratio: 0.29; 95% confidence interval: 0.08–0.99; p = 0.049). There were no other significant associations between the LMC and severe maternal morbidity.

Conclusion A higher proportion of high-risk pregnancies were managed within level IV units, although there was no overall evidence that these births had superior outcomes. Further prospective evaluation of LMC designation with patient outcomes is necessary to determine the impact of regionalization on maternal outcomes.

Keywords

maternal morbidity - levels of care - regionalization - maternal outcomes

Note

This study was presented at the 2016 Society for Maternal–Fetal Medicine Meeting.


Supplementary Material