The effect of ten years of regionalized perinatal health care in Iowa, U.S.A.

In 1973, Iowa, a rural, midwestern state in the U.S.A., established a Statewide Perinatal Care Program. A major objective was to develop and maintain a regionalized system of care. Such a system has been developed but differed from traditional systems by using regional level II centers. Iowa's low population density necessitated this modification. The development and maintenance of Iowa's system is described. Evaluation is provided by analysis of commonly available birth and mortality data. Improved birth-weight-specific neonatal and fetal mortality rates suggest an overall improvement in care. A more favorable birth weight distribution and evidence of screening and selective referral of high-risk patients provide evidence of improvements in prenatal care. Data are presented to show that a stratified system of care is evidence in the state. Level I hospitals currently manage low-risk patients and report very low mortality rates. Level II facilities receive high-risk referrals, but selective referral occurs since the tertiary center accounts for a disproportionate number of fetal and neonatal deaths, and births weighting less than 1500 g. Other regions may benefit from similar approaches to development of regionalized systems of care and evaluation of the same.