Effect of Losing Hospital-Based Obstetric Services on Maternal Health in Rural Communities

项目总结/摘要 在美国，在获得以医院为基础的产科护理方面存在着惊人的城乡差距， 城市和农村社区之间在获得服务方面的差距正在扩大。获得医院产科服务的机会 保健对怀孕前、怀孕期间和怀孕后的健康结果至关重要。严重孕产妇死亡率 在美国，发病率和孕产妇死亡率正在上升，特别是生活在农村社区的母亲。 我们对缺乏医院产科护理是否可能在不良妊娠中发挥作用知之甚少。 农村地区的孕产妇结局。这项研究有两个目标。首先，我们估计损失的影响 美国农村县获得基于医院的产科护理的孕产妇健康结果 在分娩时，使用Vital，按种族/民族和母亲教育程度测试差异 统计2005-2018年出生证明记录。其次，我们估计政策的规模- 直接和间接影响农村母亲健康结果的相关因素， 获得产科护理;这些政策相关因素包括国家的ACA医疗补助扩张 现状、医院特点和当地市场特点。这些发现旨在提供 提供关于农村医院和产科关闭对健康造成的后果的新资料， 公共政策可以用来抵消一些影响。

Project Summary / Abstract There are striking urban/rural disparities in access to hospital-based obstetric care in the US, and the gap in access between urban and rural communities is growing. Access to hospital-based obstetric care is critical to health outcomes before, during, and after pregnancy. Rates of severe maternal morbidity and maternal mortality are rising in the US, particularly for mothers living in rural communities. We know little about whether lack of access to hospital-based obstetric care may play a role in adverse maternal outcomes in rural areas. This study has two goals. First, we estimate the effect of losing access to hospital-based obstetric care in rural U.S. counties on maternal health outcomes measured at the time of delivery, and test for disparities by race/ethnicity and by maternal education, using Vital Statistics birth certificate records from 2005-2018. Second, we estimate the magnitudes of policy- relevant factors affecting rural mothers’ health outcomes directly as well as indirectly through loss of access to obstetric care; these policy-relevant factors include the state’s ACA Medicaid expansion status, hospital characteristics, and local market characteristics. These findings are intended to provide new information on the health consequences of rural hospital and obstetric unit closures, and how public policies can be used to offset some of the impact.