Jennifer's Personal Notes, Research

How hard will be be to organize maternity hospitals in the United States?

Today I want to share two studies describing what may be considered the ‘capacity’ of hospitals. 1 2  The research team surveyed hosptials in California about their staffing, treatments available, and the types of treatments they are able to provide. Why? Because the joint ACOG/SMFM statment on regionalization of hosptials organized hosptials by thier ‘capacity’.3

These papers point out the complex task ahead if states try to transform to this definition of a regionalized system.  For example, only 14.6% of hosptials had all the requirements for the basic level of maternity care but NOT all the requirements for the next level.  The intermediate level was achieved by 17.%, and the regional center was achieved by 2.1%.   When they removed one of the criteria, the proporiton of basic level hosptials jumped to 31%, intermediate to 31%, and regional to 8.4%. You may be noticing this means a number of hosptials did not meet even basic criteria.

The authors rightly point out that studies rarely control for the types of services available in hosptials when they are comparing outcomes; the data usually is not available.  Instead researchers depend on inconsistent proxies such as size, teaching status, number of deliveries per annum, or whatever the state definitions of levels may be. At this point, we do not yet know which of the requirements are associated with outcomes.  We also do not know if triaging women according to some existing risk criteria will send the correct women to the correct hosptials and result in decreased morbidity and mortality.  But I know the research community is working on answering these questions — they are the main point of my dissertation project.

1.
Korst L, Feldman D, Bollman D, et al. Variation in childbirth services in California: a cross-sectional survey of childbirth hospitals. Am J Obstet Gynecol. 2015;213(4):523.e1-8. [PubMed]
2.
Korst LM, Feldman DS, Bollman DL, et al. Cross-sectional survey of California childbirth hospitals: implications for defining maternal levels of risk-appropriate care. American Journal of Obstetrics and Gynecology. 2015;213(4):527.e1-527.e12. doi: 10.1016/j.ajog.2015.07.014
3.
Obstetric Care Consensus No. 2: Levels of maternal care. Obstet Gynecol. 2015;125(2):502-515. [PubMed]
Jennifer (Author)