ResearchObstetricsVariation in childbirth services in California: a cross-sectional survey of childbirth hospitals
Section snippets
Materials and Methods
The study was approved by the Cedars-Sinai Institutional Review Board (protocol PRO00032669 certified exempt) and complied with all stipulated criteria for participant protection.
Results
The domains and subdomains of childbirth services as represented in the conceptual framework are listed in Table 1.
The survey response rate was 96% (239 of 248), with 25 IDS, 27 teaching, and 187 community hospitals reporting. Nine hospitals, 4 IDS, and 5 community hospitals did not respond. The 4 IDS hospitals were large urban hospitals with delivery volumes ranging from 2000 to 5000 annual births. Of the 5 nonresponding community hospitals, 2 had rural status with approximately 400 annual
Comment
This study describes a thorough inventory of hospital childbirth services in California. It illustrates the technical complexity and broad diversity of the resources involved in the provision of obstetrical care, suggesting that the variation in hospital-level services may provide some basis for variation in the outcomes achieved by childbirth hospitals.
We analyzed the data by hospital type (ie, community, teaching, and IDS) because of inherent substantial differences in hospital infrastructure
Acknowledgment
We are grateful to the many individuals and organizations that have contributed to this effort, including the staff of all of the participating hospitals. We specifically acknowledge the Regional Perinatal Programs of California for their assistance in providing introductions and contact information for participants, and Kevin Van Otterloo (Community Perinatal Network in Yorba Linda, CA) for his assistance with recruitment and scheduling participant interviews (funded in part by the March of
References (30)
- et al.
Putting the “M” back in maternal-fetal medicine
Am J Obstet Gynecol
(2013) - et al.
Monitoring childbirth morbidity using hospital discharge data: further development and application of a composite measure
Am J Obstet Gynecol
(2014) Levels of maternal care. ACOG Obstetric Care consensus no. 2
Obstet Gynecol
(2015)- et al.
Level and volume of neonatal intensive care and mortality in very-low-birth-weight infants
N Engl J Med
(2007) - et al.
Perinatal regionalization for very low-birth-weight and very preterm infants
JAMA
(2010) - et al.
The effect of neonatal intensive care level and hospital volume on mortality of very low birth weight infants
Med Care
(2010) - et al.
Births: final data for 2012
Natl Vital Stat Rep
(2013) The definition of quality and approaches to its assessment. Explorations in quality assessment and monitoring, Vol 1
(1980)- et al.
A conceptual framework for hospital quality management
Int J Health Care Qual Assur
(2003) - California Code of Regulations. Title 22. Social Security. Available at:...
Vaginal birth after cesarean: do California hospital policies follow national guidelines?
J Reprod Med
Cited by (15)
Using Potentially Preventable Severe Maternal Morbidity to Monitor Hospital Performance
2023, Joint Commission Journal on Quality and Patient SafetyCitation Excerpt :In brief, California hospitals with an average annual delivery volume ≥ 200 and deliveries in all three years of study 2016–2018 were included (N = 225). Given that childbirth hospitals are known to differ substantially with respect to their resources, policies, practices, discharge coding intensity, and case mix,10 and that hospital performance comparisons are likely to be more interpretable when compared to peer institutions, California hospitals were classified into one of four types: (1) Community, (2) Teaching, (3) Integrated Delivery System (IDS), and (4) IDS Teaching. These hospital types are mutually exclusive and were analyzed separately.
Severe Maternal Morbidity in California Hospitals: Performance Based on a Validated Multivariable Prediction Model
2021, Joint Commission Journal on Quality and Patient SafetyCitation Excerpt :These exclusions reduced the overall three-year sample from 1,371,767 live births in 271 hospitals to 1,357,250 births in 225 hospitals. Given that hospitals are known to differ substantially with respect to their resources, policies, practices, and case-mix,20–22 hospital performance comparisons are likely to be more interpretable when compared to peer institutions.18 Furthermore, public health practice for the design, implementation, and tracking of quality improvement (QI) strategies will likely vary based on these differences.
Variation in Hospital Intrapartum Practices and Association With Cesarean Rate
2017, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal NursingCitation Excerpt :We found notable differences in staffing arrangements, labor management policies, and performance review processes across hospitals. A recent descriptive analysis of childbirth hospitals in California also found considerable variation in a range of maternity services, practices, and resources across hospitals (Korst et al., 2015). Such variation may carry important implications for patient outcomes and resource use and warrant further research.
Clues for understanding hospital variation among obstetric services
2015, American Journal of Obstetrics and GynecologyDevelopment and testing of a survey measure of organizational perinatal patient-centered care culture
2022, Health Services ResearchNational Trends in Survival and Short-Term Outcomes of Periviable Births ≤24 Weeks Gestation in the United States, 2009 to 2018
2022, American Journal of Perinatology
The funding sources had no involvement in the conduct of the research or preparation of the manuscript.
Financial support was provided by the Agency for Healthcare Research and Quality (grant 5 R01 HS020915) (all investigators except D.S.F.). Additional support was provided by the March of Dimes (to L.M.K., M.F., and D.L.B.) and by the American College of Obstetricians and Gynecologists/Duchesnay USA Research Award in Quality Improvement in Maternity Care (to D.S.F.).
The authors report no conflict of interest.
Cite this article as: Korst LM, Feldman DS, Bollman DL, et al. Variation in childbirth services in California: a cross-sectional survey of childbirth hospitals. Am J Obstet Gynecol 2015;213:523.e1-8.
- †
Deceased.