Impact of Obstetric Unit Closures on Pregnancy Outcomes

产科关闭对妊娠结局的影响

• 批准号: 8320004
• 负责人: Scott A Lorch
• 金额: $ 46.66万
• 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/8320004
• 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）：鉴于每年在医院中分娩了400万超过400万婴儿，因此提供产科护理是医疗保健系统的关键部分。尽管在给定地理区域中产科床的最佳供应尚不清楚，但产科单位封闭是常见的。加利福尼亚医院的先前工作表明，当医院消除某些服务领域时，产科护理是最常见的服务领域。有许多因素导致这些关闭，包括增加渎职保费，财务损失和对诉讼的恐惧。此外，这些封闭通常会对少数民族和低收入社区产生不成比例的影响。鉴于每年接受产科护理的大量妇女，因此产科关闭可以对社区的健康成果产生重大影响是合理的。但是，这些关闭对周围人口健康的影响尚未得到很好的描述。我们的小组先前已经调查了费城，在1995年至2005年之间，19个产科单位中有9个关闭。这项研究表明，与1995 - 1996年关闭前的期间相比，产科床供应的减少导致新生儿死亡率和所有胎儿死亡率的最初增加，所有通过塞司（Cesarean）部分的交付量的初始和晚期下降。这种观察提出了关于即使少量产科单位关闭对短期和长期产科护理的影响的影响。没有研究这些产科关闭对（a）居住在封闭的产科单位和（b）较大地理区域内的患者的成本，结果和护理质量的影响。我们在费城的发现以及一项研究表明，在停产产科服务后，密苏里州农村体重较低的婴儿患病率增加了，强调了有必要进行特定研究，以评估产科单位封闭后评估母体和新生儿的结果。实际上，如果产科单位关闭会对直接和周围的社区产生不利影响，那么在准备封闭以打击这些不利影响时，有可能在社区中产生重大的系统变化。在向医院管理人员，产科领导人和政府官员提供指导之前，提出了大量资源利用来打击产科单位关闭影响，需要进行严格的研究以研究封闭对孕产妇和新生儿结果的影响。研究关闭每年影响超过400万妇女及其家庭的服务的影响至关重要。 。 公共卫生相关性：尽管每年在美国分娩的400万婴儿，但通过关闭产科单位减少产科服务是很普遍的情况。该申请将调查封闭产科单位对较大社区和较小社区的怀孕成果的影响。对这种减少对产科市场的影响的影响的理解得以提高，这将导致更有效地利用医疗服务，并优化用于产科护理上的医疗保健资金的价值。