Jennifer Vanderlaan1, Roger Rochat2, Bryan Williams3, Anne Dunlop3, Susan E Shapiro3. 1. Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia. Electronic address: javande@emory.edu. 2. Emory University Rollins School of Public Health, Atlanta, Georgia. 3. Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia.
Abstract
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.
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.
Authors: Jennifer Vanderlaan; Anne Dunlop; Roger Rochat; Bryan Williams; Susan E Shapiro Journal: BMC Pregnancy Childbirth Date: 2019-10-21 Impact factor: 3.007
Authors: Lisa M Korst; Kimberly D Gregory; Lisa A Nicholas; Samia Saeb; David J Reynen; Jennifer L Troyan; Naomi Greene; Moshe Fridman Journal: Matern Health Neonatol Perinatol Date: 2021-01-06