ResearchObstetricsThe impact of hospital obstetric volume on maternal outcomes in term, non–low-birthweight pregnancies
Section snippets
Materials and Methods
This was a retrospective cohort study of California deliveries in 2007-2008, with the use of linked vital statistics/patient discharge data. The California Patient Discharge Data, Vital Statistics Birth Certificate Data, and Vital Statistics Death Certificate data are linked and maintained by the Office of Statewide health Planning and Development (OSHPD), Healthcare Information Resource Center, under the California Health and Human Services Agency.25 The dataset contains patient discharge data
Results
There was a total of 267 maternity hospitals in California that met study criteria, with a total of 736,643 deliveries. Two hundred eleven hospitals with 678,622 deliveries were located in nonrural locations, and 56 hospitals were located in rural locations, with 58,021 deliveries (Table 2). The larger hospitals in categories 3 and 4 cared for more black and Asian American women compared with the smallest hospitals (categories 1 and 2), which cared for a larger share of white women (categories
Comment
In this large retrospective cohort of term non–low-birthweight California deliveries, we observed some differences in maternal quality outcomes by hospital volume category. The lowest- and medium-volume rural hospitals exhibited higher rates of postpartum hemorrhage compared with higher-volume rural hospitals, which is a difference that persisted after confounder adjustment. Although most outcomes did not differ in nonrural hospitals, rates of prolonged LOS after chorioamnionitis and
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2020, Journal of Clinical AnesthesiaCitation Excerpt :Recognizing the factors external to the individual patient that influence patient-level SMM, several recent studies have incorporated multilevel modeling into their analyses [5–7,15]. Hospital-level factors that have been previously shown to influence maternal health include the hospital's rural or urban location, where women in the former are affected by issues of geographic impediments to access [16,17]; the proportion of black patients treated across all cases in a hospital, where both white and black patients treated in these predominately minority-serving hospitals have higher risk of SMM [8], and delivery volume, where higher volume hospitals are associated with less SMM [9,18,19]. Hospital safety-net burden, defined as the percentage of total cases billed to Medicaid or those whom were not insured, has also been suggested as a factor [9].
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2019, International Journal of Obstetric AnesthesiaCitation Excerpt :As the number of deliveries drops, the medical expertise required to treat cases with greater complexity may be lost.92 Of some concern is the inverse association existing between hospital obstetrical caseload and the rate of postpartum complications,93 particularly with respect to the management of peripartum hemorrhage.94 When a pregnant woman is critically-ill, both the mother and fetus are at risk.
Supported by grant number R40 MC 25694-01-00 from the Maternal and Child Health Research Program, Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services (J.M.S. and A.B.C.), and by the UCSF Women’s Reproductive Health Research Career Development Award, NIH, Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12 HD001262, Y.W.C.).
The content is solely the responsibility of the authors and does not necessarily represent the official views of National Institutes of Health or Health Resources and Services Administration.
The authors report no conflict of interest.
Cite this article as: Snowden JM, Cheng YW, Emeis CL, et al. The impact of hospital obstetric volume on maternal outcomes in term, non–low-birthweight pregnancies. Am J Obstet Gynecol 2015;212:380.e1-9.