Impact of Obstetric Unit Closures on Pregnancy Outcomes

产科关闭对妊娠结局的影响

• 批准号: 8036811
• 负责人: Scott A Lorch
• 金额: $ 45.6万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8036811
• 关键词: Impact; Obstetric; Unit; Closures; Pregnancy

DESCRIPTION (provided by applicant): Given the fact that over 4 million infants are delivered in hospitals every year, the provision of obstetric care is a critical part of the health care system. Although the optimal supply of obstetric beds in a given geographic region is unknown, obstetric unit closures are a common occurrence. Prior work from California hospitals has shown that, when a hospital is eliminating certain service areas, obstetric care was the most common service area to be eliminated. There are many factors contributing to these closures including increasing malpractice premiums, financial losses and fear of litigation. Additionally, these closures often disproportionately affect minority and low-income communities. Given the large number of women annually that receive obstetric care, it is plausible that obstetric closures can have a significant impact on the health outcomes of communities. However, the impact of these closures on the health of the surrounding population is not well described. Our group has previously investigated Philadelphia, where 9 of 19 obstetric units closed between 1995 and 2005. This study showed that, compared to a pre-closure period of 1995-1996, this reduction in obstetric bed supply resulted in an initial increase in neonatal and all fetal mortality, an initial and late decline in the number of deliveries via Cesarean section. This observation raises multiple questions about the impact of even a small number of obstetric unit closures on short-term and long-term outcomes of obstetric care. There are no studies of the impact of these obstetric closures on the costs, outcomes, and quality of care for both (a) patients who reside close to the closed obstetric unit and (b) patients within the larger geographic area, nor are there studies to understand how characteristics of the health care market and the hospitals that close modify these associations. Our findings in Philadelphia and a study demonstrating increased prevalence in babies with low birth weight in rural Missouri after discontinuation of obstetric services, highlight the need to have specific studies dedicated to evaluating maternal and neonatal outcomes after obstetric unit closures. If in fact obstetric unit closures adversely impacts both the immediate and surrounding communities, there is the potential to create significant systems changes in communities when preparing for a closure to combat these adverse affects. Prior to providing guidance to hospital administrators, obstetrical leaders, and government officials suggesting significant resource utilization to combat obstetric unit closure affects, rigorous research is needed to study the effect of closures on maternal and neonatal outcomes. Studying the impact of closing a service that impacts over 4 million women and their families each year is of great societal importance. . PUBLIC HEALTH RELEVANCE: Although over 4 million infants delivering in the United States every year, the reduction of obstetric services through the closure of obstetric units is a common occurrence. This application will investigate the impact of obstetric unit closures on the pregnancy outcomes of both the larger community and the smaller community serviced by the closed obstetric unit. Improved understanding of the impact of such service reductions in the obstetric market will result in more efficient use of health care services and optimize the value of health care dollars spent on obstetric care.

描述（由申请人提供）：鉴于每年有超过 400 万婴儿在医院分娩，提供产科护理是医疗保健系统的重要组成部分。尽管特定地理区域产科床位的最佳供应情况尚不清楚，但产科单位关闭的情况很常见。加州医院之前的研究表明，当医院取消某些服务领域时，产科护理是最常见的被取消的服务领域。导致这些关闭的因素有很多，包括医疗事故保费增加、经济损失和对诉讼的恐惧。此外，这些关闭往往对少数族裔和低收入社区造成不成比例的影响。鉴于每年有大量妇女接受产科护理，关闭产科可能会对社区的健康结果产生重大影响。然而，这些关闭对周围人口健康的影响尚未得到很好的描述。我们的小组之前曾对费城进行过调查，该地区 19 个产科单位中有 9 个在 1995 年至 2005 年间关闭。这项研究表明，与关闭前的 1995 年至 1996 年相比，产科床位供应的减少导致新生儿和新生儿数量的最初增加。所有胎儿死亡率，剖腹产分娩数量的初始和晚期下降。这一观察结果引发了多个问题，即即使是少量产科关闭也会对产科护理的短期和长期结果产生影响。目前还没有研究关闭产科对 (a) 居住在关闭产科病房附近的患者和 (b) 较大地理区域内的患者的成本、结果和护理质量的影响，也没有研究了解医疗保健市场和相关医院的特征如何改变这些关联。我们在费城的研究结果和一项研究表明，在停止产科服务后，密苏里州农村地区低出生体重婴儿的患病率有所增加，这突显了需要开展专门研究来评估产科关闭后孕产妇和新生儿结局的必要性。如果事实上产科单位的关闭对附近社区和周边社区都产生了不利影响，那么在准备关闭以应对这些不利影响时，就有可能在社区中造成重大的系统变化。在向医院管理人员、产科领导和政府官员提供指导，建议利用大量资源来应对产科关闭的影响之前，需要进行严格的研究来研究关闭对孕产妇和新生儿结局的影响。研究关闭一项每年影响超过 400 万妇女及其家庭的服务的影响具有重大社会意义。 。 公共卫生相关性：尽管美国每年有超过 400 万婴儿分娩，但由于关闭产科单位而导致产科服务减少的情况很常见。该应用程序将调查产科病房关闭对较大社区和由关闭产科病房服务的较小社区妊娠结局的影响。更好地了解产科市场服务减少的影响将导致更有效地利用医疗保健服务，并优化用于产科护理的医疗保健资金的价值。