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Differential markers for regionalization.

S Mehta1, H D Atherton, P J Schoettker

  • 1Division of Health Policy and Clinical Effectiveness, Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.

Journal of Perinatology : Official Journal of the California Perinatal Association
|September 26, 2000
PubMed
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Regionalization of perinatal care shows significant variation in delivery locations for very low birth weight (VLBW) infants and infants with major congenital malformations (MCM). Delivery at level III hospitals for MCM infants may offer an alternative regionalization measure.

Area of Science:

  • Perinatal care
  • Neonatal outcomes
  • Public health policy

Background:

  • Perinatal regionalization aims to optimize care for high-risk newborns.
  • Assessing the effectiveness of regionalization requires evaluating delivery site patterns.
  • Very low birth weight (VLBW) infants and infants with major congenital malformations (MCM) represent critical populations for regionalized care.

Purpose of the Study:

  • To investigate the delivery site patterns for VLBW infants and infants with MCM within Ohio's established perinatal regionalization system.
  • To identify variations in delivery locations across different perinatal regions and over time.

Main Methods:

  • Retrospective analysis of delivery data for VLBW infants and infants with specific MCMs (tracheoesophageal fistula/esophageal atresia, diaphragmatic hernia, gastroschisis/omphalocele).

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  • Study period: 1990-1995 in Ohio.
  • Data collected on the level of hospital where infants were delivered.

    • Main Results:

    • Over half (59.8%) of VLBW infants and 36.1% of MCM infants were born in level III hospitals.
    • A significant trend showed a decrease in VLBW infants (p < 0.01) and an increase in MCM infants (p < 0.05) born in level III hospitals from 1990 to 1995.
    • Significant regional disparities were observed in the proportion of both VLBW and MCM infants delivered at tertiary centers.

    Conclusions:

    • Traditional markers like VLBW delivery site reveal substantial regional and temporal variations in perinatal care regionalization.
    • Delivery of infants with MCM at level III centers emerges as a potential alternative metric for evaluating the success of perinatal regionalization.
    • Findings underscore the need for continued assessment and potential refinement of regional perinatal care strategies.