Rethinking perinatal policy: history and evaluation of minimum volume and level-of-care standards

Area of Science:

• Healthcare Policy
• Perinatal Medicine
• Quality Improvement

Background:

• U.S. perinatal care organization has historically relied on two main standards: minimum volume (size) and technical capacity for service levels.
• These standards are structural measures of quality but may not align with outcome-based quality definitions in perinatal care.

Purpose of the Study:

• To evaluate the empirical association between dominant U.S. perinatal care organizational standards and patient outcomes.
• To assess the impact of these standards on the financial stability and cost-efficiency of tertiary-level perinatal services.

Main Methods:

• Review of empirical research examining the relationship between perinatal care standards (volume, technical capacity) and health outcomes.
• Analysis of studies investigating the economic effects of these organizational standards on healthcare services.

Main Results:

• Empirical research has not established a general link between minimum volume/technical capacity standards and improved overall perinatal outcomes.
• A positive association was found between these standards and improved outcomes specifically for very low birthweight infants.
• The standards have supported the growth and financial stability of tertiary perinatal services, but have not demonstrably lowered unit costs.

Conclusions:

• Discrepancies exist between research findings and the prevailing model of large, complex perinatal centers.
• The effectiveness and efficiency of current perinatal service organization standards require further investigation, acknowledging inherent uncertainties.